预防气管插管致高血压有哪些药？

本文由“小麻哥的日常”授权转载

摘要译文（供参考）

减轻高血压患者对喉镜暴露和气管插管的压力反应：

利多卡因和硫酸镁联合应用的效果

背景：

喉镜暴露和气管插管会导致压力反应，这可能是有害的，尤其是高血压患者，从而产生潜在的有害影响。

许多药物已被用于减轻高血压患者对喉镜暴露和气管插管的这种不期望的升压反应；其中包括单独使用不同剂量的镁或与利多卡因联合使用。

然而，已经发现药物组合比单一药物治疗更有效。

本研究比较了不同剂量的硫酸镁及其与利多卡因的组合对压力反应的缓解效果。

方法：

这是一项前瞻性、随机、双盲研究。

每次招募6名在全身麻醉下进行择期手术且需要气管插管的高血压患者（ASAII），并随机分为：

I组：静脉注射30mg/kg的MgSO4加1.5mg/kg 2%利多卡因

II组：静脉注射30mg/kg的MgSO4

III组：静脉注射40mg/kg的MgSO4

结局指标是使用研究药物后以及喉镜暴露和气管插管后，收缩压（SBP）较基线的变化。

记录了研究药物的副作用以及使用研究药物30分钟前后血清镁水平的变化。

结果：

仅I组和III组患者插管后收缩压降低。

然而，第三组中有5名患者出现低血压。

所有组的血清镁水平均高于各自的基线值。

结论：

1.5 mg/kg 2%利多卡因和30 mg/kg MgSO4的组合比30 mg/kg单独的MgSO4更有效，甚至也比更高剂量的40 mg/kg MgSO4更有效。

关键词：

血流动力学反应；喉镜暴露和气管插管；利多卡因；硫酸镁；血清MgSO4水平。

原文摘要

Attenuating the Pressor Response to Laryngoscopy and Endotracheal Intubation in Controlled Hypertensives: 

The Effect of Combining Lidocaine and Magnesium Sulphate

Background: Laryngoscopy and intubation result in a pressor response which may be deleterious especially in hypertensives, resulting in potentially harmful effects. Many drugs have been used to attenuate this undesirable pressor response to laryngoscopy and intubation in hypertensives; amongst them are magnesium alone in different doses or in combination with lidocaine. However, drug combinations have been found to be more effective than single drug therapy.

Objective: This study compared the different doses of magnesium sulphate and its combination with lidocaine for the attenuation of the pressor response.

Methods: A prospective, randomized, double-blinded study. Nighty-six controlled hypertensives (ASA physical status II) scheduled for elective surgery under general anaesthesia and who required endotracheal intubation were recruited and randomized into either Group I (they received 30mg/kg of IV MgSO4 plus 1.5mg/kg of 2% lidocaine) or Groups II and III who received 30mg/kg and 40mg/kg of IV MgSO4 alone, respectively. The outcome was the change in the systolic blood pressure (SBP) from the baseline following administration of study medication and after laryngoscopy and endotracheal intubation. The side effects of study medication and changes in serum magnesium level prior to and after 30 minutes of administering study medication were documented.

Results: The post-intubation SBP was attenuated in patients in groups I and III only. However, five patients in group III had hypotension. Serum magnesium levels were higher than their respective baseline values in all the groups.

Conclusion: The combination of 1.5 mg/kg of 2% lidocaine and 30 mg/kg of MgSO4 is more effective than 30 mg/kg of MgSO4 alone and even MgSO4at the higher dose of 40 mg/kg.

Keywords: Haemodynamic response; Laryngoscopy and endotracheal intubation; Lidocaine; Magnesium sulphate; Serum levels of MgSO4.

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本微信公众平台所刊载原创或转载内容不代表米勒之声的观点或立场。文中所涉及药物使用、疾病诊疗等内容仅供医学专业人士参考。

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编辑：MiSuper.米超

校对：Michel.米萱

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