舒芬太尼与芬太尼对非体外循环冠状动脉旁路移植术患者谵妄发生率的对比研究

摘要

目的:对比舒芬太尼与芬太尼麻醉对非体外循环下冠状动脉旁路移植术(OPCABG)患者谵妄发生率的影响.方法:拟行OPCABG的患者48例,年龄60 ～ 65岁,随机分为2组(n=24):舒芬太尼组(S组)与芬太尼组(F组).2组均静脉注射咪达唑仑、依托咪酯、维库溴铵及舒芬太尼1 ～2 μg//kg(S组),芬太尼10 ～20 μg/kg(F组)进行麻醉诱导,气管插管后行机械通气.麻醉维持:S组静脉输注舒芬太尼0.5～1.5 μg·kg-1 ·h-1,F组静脉输注芬太尼5 ～ 15 μg· kg-1·h-1,2组均吸入0.5％(2.0％异氟烷,间断静脉注射维库溴铵.S组静脉输注舒芬太尼2 μg/h,F组输注芬太尼20 μg/h进行术后静脉镇痛.分别于术前、术后1d、2d、3d、4d及5d进行谵妄分值评估.于术前及术后1d测定血清C-反应蛋白浓度,并于记录血流动力学指标、ICU停留时间和术后并发症的发生情况.结果:与F组比较,S组术后谵妄发生率低(P＜0.01),术后1dC-反应蛋白较F组低(P＜0.05),术后发热发生率降低(P＜0.01),其他不良反应2组间差异无统计学意义(P＞0.05).结论:舒芬太尼-复合麻醉可降低OPCABG患者术后炎症反应程度,并降低术后谵妄的发生率.%Objective;To compare the postoperative Delirium between group sufentanil and fentanyl for patients undergoing off-pump coronary artery bypass grafting(OPCABG). Methods; Forty-eight patients aged 60-65years scheduled for OPCAB were randomly devided into group sufentanil (group S n =24) and group fent-anyl (group F, n = 24). Anesthesia was induced with midazolam, etomidate, vecuronium combined with sufen-tanil 10-20μg/kg( group S) and fentanyl 10-20μg/kg( group F)' maintained with 0.5%-2% isoflurane and 4 mg/h vecuronium, combined sufentanil 0. 5-1. 5 (μg·kg-1·h-1 in group S, fentanyl 5-15 μg·kg-1·h-1 in group F during operation. Sufentanil 2 μg/h in group S and fentanyl 20 μg/h in group F for Postoperatve analgesia. Delirium was assessed by using the intensive care delirium screening checklist before 1 day and five days after surgery. Serum C-reactive protein concentrations were determined before and 1 day after surgery. The hemody-namics, length of intensive care unit (ICU) , and postoperative complications were recorded. Results; Com-pared with group F, The incidence of postoperative delirium was lower for those receiving sufentanil analgesia (P < 0. 01). Serum C-reactive protein concentrations was also lower in the sufentanil treated patients ( P < 0. 05). Postoperative febrile reactions were reduced significantly in group S( P <0. 01). There were no signifi-cant differences with hemodynamie variables at every time points. No differences between the groups were noted with postoperative complications (P > 0. 05 ). Conclusion: Compared with group F, sufentanil can attenuates postoperative delirium concomitant with an anti-inflammatory effect and benefit the prognosis for patients under-going OPCAB.