舒芬太尼复合丙泊酚靶控输注对心脏瓣膜置换患者气管插管和转流前血流动力学的影响

摘要

Objective To investigate the effects of different effect site concentrations(Ce) of sufentanil and same Ce of propfol target-controlled infusion(TCI) on hemodynamic response to tracheal intubation and before cardiopulmonary bypass (CPB) in patients undergoing cardiac valve replacement.Methods Forty-eight ASA Ⅱ or Ⅲ patients aged 32-59 years old with rheumatic heart disease undergoing valve replacment were randomly divided into four groups(n=12) according to Ce of sufentanil: 0. 6 ng/ml (group Ⅰ), 0. 8 ng/ml (group Ⅱ), 1.0 ng/ml (group Ⅲ ) and 1. 2 ng/ml (group Ⅳ ). HR, MAP, CVP and Bispectral Index(BIS) were monitored continuously. Anesthesia was induced with midazolam 0.05 mg/kg,sufentanil TCI at Ce 0. 6 ng/ml(group Ⅰ) ,0.8 ng/ml(group Ⅱ), 1.0 ng/ml(group Ⅲ ) and 1.2 ng/ml(group Ⅳ), propofol TCI at Ce 1.8 μg/ml and rocuyonium 0.9 mg/kg. The hemodlynamic and BIS parameters were recorded before induction(T0, baseling), after induction (T1), 1 min(T2 ), 3 min(T3 ), 5 min(T4 )after intubation, before and after skin incision (T5 ,T6 ) ,open sternum(T7 ) ,and 5 minute before CPB(T8 ).Results Compared with group Ⅰ, Heart rate of T1 of group Ⅲ and T1-T3 of group Ⅳ were slower (P＜0.05), and MAP of T1 and T2 of group Ⅳ were lower(P＜0.05). There were no significant different in otherhenmodynarnic parameters and BIS among the four groups. But use of vasoactive agent was significant different among the four groups(P＜0. 05) and percentage of use of vasoactive agent of group Ⅲ was lower (P＜ 0. 05). Conclusion Sufentanil TCI at Ce 0. 6 ng/ml, 0.8 ng/ml, 1.0 ng/ml and 1.2 ng/ml,compounded propofol TCI at Ce 1.8 μg/ml could inhibit hemodynamic response to tracheal intubation and before CPB in patients undergoing cardiac valve replacement. But henodynamic of sufentanil TCI at Ce 1.0 ng/ml compounded propofol is nore stable.%目的 评价不同效应室浓度(C=e)的舒芬太尼复合相同Ce的丙泊酚靶控输注(TCI)对心脏瓣膜置换患者气管插管和心肺转流(CPB)前血流动力学的影响.方法 择期在CPB下行心脏瓣膜置换术的风湿性心脏病患者48例,根据舒芬太尼Ce,随机均分为四组.麻醉诱导:咪达唑仑0.05mg/kg,丙泊酚Ce 1.8μg/ml TCI,罗库溴铵0.9mg/kg,舒芬太尼靶控浓度分别为0.6 ng/ml(Ⅰ组)、0.8ng/ml(Ⅱ组)、1.0 ng/ml(Ⅲ组)、1.2 ng/ml(Ⅳ组).记录麻醉诱导前(T<,0>)、麻醉诱导后(T<,1>)、气管插管后1 min(T<,2>)、3min(T<,3>)、5 min(T<,4>)、切皮前(T<,5>0、切皮时(T<,6>)、劈胸时(T<,7>)及(CPB 前 5 min(T<,8>)的HR、MAP、中心静脉压(CVP)及脑电双频指数(BIS),并统计气管插管和CPB前血管活性药物的使用情况.结果 与Ⅰ组比较,T<,1>时Ⅲ组、T<,1>～T<,3>时Ⅳ组的HR明显减慢(P<0.05);T<,1>、T<,2>时Ⅳ组的MAP明显降低(P<0.05).在血管活性药物的使用上,Ⅲ组使用去氧肾上腺素、尼卡地平、艾司洛尔的病例少于Ⅰ组(P<0.05),Ⅳ组使用尼卡地平、艾司洛尔病例少于Ⅰ组(P<0.05).结论 不同Ce的舒芬太尼复合Ce为1.8 μg/ml的丙泊酚TCI均能抑制心脏瓣膜置换术患者气管插管和CPB前的血流动力学应激反应,其中1.0 ng/ml的舒芬太尼复合1.8 μg/ml的丙泊酚TCI能更有效维护心脏瓣膜置换术患者气管插管和CPB前的血流动力学稳定.