【摘要】 目的 比较瑞芬太尼、丙泊酚、艾司洛尔用于支撑喉镜手术气管插管时患者的心血管反应。 方法 选取2009年1-3月就诊的60例拟于全身麻醉下行择期支撑喉镜下声带息肉切除术的患者，随机分为丙泊酚组、艾司洛尔组和瑞芬太尼组，每组20例。麻醉诱导采用咪达唑仑、芬太尼和丙泊酚，患者意识消失后给予琥珀胆碱。1 min后各组分别给予丙泊酚2 mg/kg、艾司洛尔1 mg/kg和瑞芬太尼1 μg/kg。30 s后进行气管插管。记录患者诱导前及插管前、插管后1、3、5 min的心率和血压水平。 结果 各组插管前的收缩压和心率较诱导前明显降低，插管后1、3 min的收缩压和心率较插管前升高（Plt;0.05)。丙泊酚组和艾司洛尔组插管后的收缩压较瑞芬太尼组升高（Plt;0.05)。丙泊酚组插管后心率较瑞芬太尼组增加（Plt;0.05)。 结论 对行支撑喉镜手术的患者，气管插管前30 s给予1 μg/kg瑞芬太尼较2 mg/kg丙泊酚和1 mg/kg艾司洛尔能更有效地减轻气管插管时的血流动力学反应。【Abstract】 Objective To assess the different effects of remifentanil, propofol, and esmolol on hemodynamic responses during intubation in CO2 laser endolaryngeal microsurgery (CO2-LELM). Methods A total of 60 patients aged from 18 to 65 years, admitted from January to March 2009 and scheduled to undergo elective CO2-LELM under general anesthesia for treatment of vocal cord polyp were randomly assigned to a propofol group, an esmolol group, and a remifentanil group. Anesthesia was induced with midazolam (0.015-0.02 mg/kg), fentanyl (1 μg/kg), and propofol (1 mg/kg). After the patients became unconscious, succinylcholine (1 mg/kg) was given one minute later. Then the patients in the three groups received propofol (2 mg/kg), esmolol (1 mg/kg), and remifentanil (1 μg/kg), respectively. Intubation was performed 30 secconds later. Heart rate (HR) and systolic blood pressure (SBP) were measured noninvasively before general anesthesia induction (baseline, Tb), just before intubation(Ti), and one, three, and five minutes after intubation (T1, T3, T5). Results The demographic data including age, sex and body weight were comparable in the three groups. Tracheal intubation caused significant increases in SBP and HR in all groups compared with Ti (Plt;0.05). After intubation, SBP in the propofol group and the esmolol group were significantly higher than that in remifentanil group (Plt;0.05), and HR in the propofol group was significantly higher than that in the remifentanil group (Plt;0.05). Conclusion In patients with CO2-LELM, remifentanil (1 μg/kg) administrated 30 seconds before intubation is maximal effective compared with propofol (2 mg/kg) or esmolol (1 mg/kg) in attenuating the hemodynamic responses to oraltracheal intubation.