硝普钠预处理对高血压犬气管插管血流动力学的影响(一)

详细内容

作者：王军，张伟，王警卫，曹艳

【关键词】 硝普钠

　　Hemodynamic effect of sodium nitroprusside pretreatment for tracheal intubation in renal hypertensive dogs

　　【Abstract】 AIM: To eva luate the preventive effect on the hemodynamic stress with the pretreatment of sodium nitroprusside followed by tracheal intubation in renal hypertensive dogs. METHODS: Four dogs with renal hypertension were enrolled in the autocontrol experiment. The dogs were anesthetized by sodium pentobarbital injection (30 mg/kg) and then tracheal intubation was performed without sodium nitroprusside pretreatment. Three days later, the same dogs were given sodium nitroprusside (8 μg/kg?min) via femoral vein before intubation. In the absence or presence of sodium nitroprusside pretreatment, their blood pressure and heart rate were measured at several time points, such as exposing glottis, inserting tube and pleting intubation. The data under the two different conditions were pared by t test. RESULTS: There was significant difference in blood pressure with and without sodium nitroprusside at the time point of exposing glottis, inserting tube and pleting intubation (P0.05), while no difference was observed in heart rate. CONCLUSION: Sodium nitroprusside pretreatment can prevent the rise of blood pressure and reduce the hemodynamic stress in the process of tracheal intubation.

　　【Keywords】 sodium nitroprusside; hypertension; dogs; intubation, intratracheal

　　【摘要】目的： 在肾动脉高血压犬模型上，评价硝普钠预处理后气管插管对高血压犬血流动力学影响. 方法： 肾动脉高血压杂种犬4条，经30 mg/kg戊巴比妥钠麻醉，建立血流动力学监测体系. 用自身对照进行实验，4只犬不用硝普钠进行气管插管，连续观察血流动力学参数，测量显露声门、气管内置管和完成插管时的血压、心率. 3 d后先自股静脉泵入硝普钠8 μg/(kg?min)，血压下降20%后同样条件下气管插管，观察各时间点血流动力学指标，两组数据进行配对t检验. 结果： 硝普钠预处理与未处理犬显露声门、气管内置管和完成插管时比较，血压升高，存在显著差异(P＜0.05)，而对心率无影响. 结论： 硝普钠预处理高血压犬在显露声门、气管内置管和完成插管时血管应激反应轻，可避免高血压犬血压的进一步上升.

　　【关键词】 硝普钠；高血压；狗；插管法，气管内

　　0引言

　　随着我国逐渐进入老龄化社会，老年高血压患者需要气管插管治疗的比例有了较大的上升. 高血压患者气管插管易引起高血压危象，因此，对高血压患者气管插管血压的控制显得十分重要. 硝普钠是临床最为常用控制性降压药物，该药作用迅速、短暂、易于调节，我们采用高血压犬模型，用硝普钠在气管插管前预处理，评价对高血压犬气管插管时血流动力学的影响，为临床应用硝普钠预防高血压气管插管心血管应激反应提供依据.

　　1材料和方法

　　1.1材料

　　雄性杂种犬4只(第四军医大学实验动物中心提供)，体质量13～17 kg，在室温(22±2)℃，相对湿度（65±10）%环境下，用自制饲料及过滤自来水饲养. 硝普钠(北京双鹤现代医药技术有限责任公司)，粉针剂，每支50 mg（批号京卫药准字0004221）.

　　1.2方法

　　1.2.1模型制备将犬以戊巴比妥钠30 mg/kg麻醉，无菌条件下行双侧肾动脉狭窄另加右侧肾包扎术. 用丝线“8”字形绕肾门结扎，使双侧肾动脉狭窄到原血管的1/3或1/2，右侧肾钝性分离包膜后套上乳胶套至顶部包紧. 在肾门处连同肾蒂一起打结(不压迫血管)，翻转剩下部分至肾缘，紧靠肾缝扎，剪去余下乳胶套并缝至后壁，固定右侧肾. 术后10 d拆线. 术后1 mo，选用收缩压150 mmHg(1 mmHg=0.133 kPa)，舒张压110 mmHg以上的动物4只进行实验.