艾司洛尔对胃食管交接区的影响：14名健康志愿者随机、双盲的交叉研究
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Effects of Esmolol on the Esophagogastric Junction: A Double-Blind, Randomized, Crossover Study on 14 Healthy Volunteers
背景与目的
被动的反流可能发生在整个围手术期，增加肺部误吸和术后肺部并发症的风险。食管胃交界区（EGJ）是阻止胃内容物被动反流的屏障。在麻醉期间使用的催眠药和阿片样物质，特别是瑞芬太尼已证明能降低食管胃交界处（EGJ）中的压力。通常用于抵抗心动过速和高血压的艾司洛尔已被证明在全身麻醉期间具有很强的实用性。像瑞芬太尼一样，β1-肾上腺素受体拮抗剂可用于减轻气管插管的应激反应，并改变围手术期麻醉需求。也可能减少术后阿片类药物的需要。然而，它对EGJ的作用是未知的。 该试验的目的是比较艾司洛尔和瑞芬太尼作为单一药物时对健康志愿者EGJ压力的影响。
方 法
用高分辨率固态测压法在14名健康志愿者中测量EGJ压力。干预是随机进行的，将艾司洛尔其以静脉注射剂量1mg/kg静脉给予，然后以10μg·kg/min输注15分钟。以目标控制输注法注射瑞芬太尼在15分钟内达到效应浓度4ng/mL。药物给药期间在基础时、2分钟（T2）和15分钟（T15）时测量EGJ。 主要需要的结果是吸气EGJ增加值，而吸气和呼气时的EGJ压力值是其次的结果。
结 果
比较瑞芬太尼和艾司洛尔，他们在吸气时对EGJ压力的增加没有影响（平均差异-4.0 mm Hg [-9.7至1.7]; P = 0.15）。 相比之下，与艾司洛尔相比，瑞芬太尼显着降低吸气和呼气时EGJ的压力（-12.2 [-18.6至-5.7]; P = .003和-8.0 [-13.3至-2.8]; P = .006）。
结 论
艾司洛尔与瑞芬太尼相比，不影响EGJ功能。 针对反流误吸来说可能是优点，因此艾司洛尔可以在麻醉中发挥作用，其中EGJ屏障功能的维持是非常重要的。
原始文献摘要
Dexter, Franklin; Epstein, Richard H.; Sun, Eric C.; Readmissions to Different Hospitals After Common Surgical Procedures and Consequences for Implementation of Perioperative Surgical Home Programs；Anesthesia & Analgesia . 125(3):943-951, September 2017.
BACKGROUND: Passive regurgitation may occur throughout the perioperative period, increasing the risk for pulmonary aspiration and postoperative pulmonary complications. Hypnotics and opioids, especially remifentanil, that are used during anesthesia have been shown to decrease the pressure in the esophagogastric junction (EGJ), that otherwise acts as a barrier against passive regurgitation of gastric contents. Esmolol, usually used to counteract tachycardia and hypertension, has been shown to possess properties useful during general anesthesia. Like remifentanil, the β-1-adrenoreceptor antagonist may be used to attenuate the stress reaction to tracheal intubation and to modify perioperative anesthetic requirements. It may also reduce the need for opioids in the postoperative period. Its action on the EGJ is however unknown. The aim of this trial was to compare the effects of esmolol and remifentanil on EGJ pressures in healthy volunteers, when administrated as single drugs.
METHODS: Measurements of EGJ pressures were made in 14 healthy volunteers using high-resolution solid-state manometry. Interventions were administered in a randomized sequence and consisted of esmolol that was given IV as a bolus dose of 1 mg/kg followed by an infusion of 10 μg·kg −1 ·min −1 over 15 minutes, and remifentanil with target-controlled infusion of 4 ng/mL over 15 minutes. Interventions were separated by a 20-minute washout period. Analyses of EGJ pressures were performed at baseline, and during drug administration at 2 (T2) and 15 minutes (T15). The primary outcome was the inspiratory EGJ augmentation, while the inspiratory and expiratory EGJ pressures were secondary outcomes.
RESULTS: There was no effect on inspiratory EGJ augmentation when comparing remifentanil and esmolol (mean difference −4.0 mm Hg [−9.7 to 1.7]; P = .15). In contrast, remifentanil significantly decreased both inspiratory and expiratory pressures compared to esmolol (−12.2 [−18.6 to −5.7]; P = .003 and −8.0 [−13.3 to −2.8]; P = .006).
CONCLUSIONS: Esmolol, compared with remifentanil, does not affect EGJ function. This may be an advantage regarding passive regurgitation and esmolol may thus have a role to play in anesthesia where maintenance of EGJ barrier function is of outmost
importance
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