加巴喷丁对置入喉罩时血流动力学及儿茶酚胺的影响

Gabapentin Reduces Cardiovascular Responses and Inhibites Secretion of Catecholamines Secondary to Inserting the Laryngeal Mask Airway

关键词:  喉罩  加巴喷丁  应激反应  儿茶酚胺

Key words:  laryngeal mask airway  gabapentin  cardiacvascular response  catecholamine

摘要:

目的 观察服用加巴喷丁后对置入喉罩时心血管系统的反应和血中儿茶酚胺的变化。方法 选择无心血管疾病，ASA分级Ⅰ~Ⅱ级，择期行上下肢骨折手术的患者40例，随机分成两组：加巴喷丁组(G组)和对照组(C组)，每组各20例。分别于下列时间点观察血流动力学变化：手术前(T₀)，泵注丙泊酚4 min(T₁)，置入喉罩过程中(T₂)，置入喉罩后1 min(T₃)，置入喉罩后3 min(T₄)，置入喉罩后5 min(T₅)。同时分别在T₀、T₅从动脉通路中抽取血液5 mL。血标本用ELISA法测定儿茶酚胺的含量。结果 两组患者麻醉诱导后平均动脉压均下降(P<0.05)；喉罩置入过程中，C组的平均动脉压和心率明显升高(P<0.05)，而G组虽有升高，但差异无统计学意义。置入喉罩前后C组血中肾上腺素和去甲肾上腺素的含量比较差异有统计学意义(P<0.05)，而G组比较差异无统计学意义。结论 术前1 h口服加巴喷丁600 mg，可以松弛咽喉部平滑肌，降低咽喉部的敏感性，达到置入喉罩时机体血流动力学平稳，并抑制儿茶酚胺释放的目的。

Abstract:

OBJECTIVE To investigate gabapentin on preventing cardiovascular responses and the level of catecholamines in the blood during the insertion of the laryngeal mask airway(LMA). METHODS Forty ASA class I or II patients without cardiovascular disease undergoing limb fracture surgery were enrolled in the study. The patients were randomizly divided into two groups, gabapentin group(G group) and control group(C group), with 20 patients in each group. In the following phase to observe changes in blood flow dynamics (MAP and HR): the basis of pre-operative value (T0), 5 minutes after induction (T₁), process of LMA insertion (T₂), 1min after LMA insertion (T₃), 3 min after LMA insertion (T₄), 5min after LMA insertion (T₅). Meanwhile, blood samples were collected from artery channel at T₀ and T₅, and the level of catecholamine was checked by ELISA method. RESULTS MAP decreased after the induction of anesthesia (P<0.05), the C group’s MAP and HR during inserting the LMA increased significantly (P<0.05), the MAP and HR in G group did not increase significantly. The levels of epinephrine and norepinephrine in C group increased significantly (P<0.05) after LMA insertion, while these in group G had no significant differences. CONCLUSION One hour before surgery, gabapentin 600 mg oral administration can relax the smooth muscle of the throat, reduce the sensitivity of the throat, can effectively reduce the cardiacvascular responses and inhibit the release of catecholamines during the insertion of the LMA.