常用剂量芬太尼与舒芬太尼对术前压力反射敏感性的影响

摘要

研究临床常用剂量的芬太尼和舒芬太尼对患者术前压力反射敏感性(BRS)的影响.方法 择期全麻剖胸手术患者60例,年龄18～65岁,ASA Ⅰ或Ⅱ级,随机均分为芬太尼组(F组)和舒芬太尼组(S组),组内按照不同用药剂量再分为三个亚组:F1组、F2组、F3组分别输注芬太尼2、4、6 μg/kg,S1组、S2组、S3组分别输注舒芬太尼0.2、0.4、0.6μg/kg.记录入室后和给药后BRS.结果 给药后F3、S2、S3组BRS均显著降低,分别下降(34.1±11.0)％、(33.5±13.0)％、(45.0±15.0)％(P＜0.05).结论 临床常用剂量芬太尼和舒芬太尼均能降低BRS,尤以芬太尼＞6 μg/kg、舒芬太尼＞0.4 μg/kg最明显.等效剂量舒芬太尼较芬太尼对压力反射的抑制作用更显著.%Objective To investigate the effects of fentanyl and sufentanil on baroreflex sensitivity in pre-operative patients. Methods Sixty patients ASA I or Ⅱ , aged 18-65 years, scheduled for elective thoracic surgery under general anesthesia were randomly assigned to receive fentanyl (group F) or sufentanil (group S). Each group was divided into three subgroups by different doses: group F1 fentanyl 2 μg/kg, group F2 fentanyl 4 μg/kg, group F3 fentanyl 6 μg/kg; group S1 sufentanil 0. 2 μg/kg, group S2 sufentanil 0. 4 μg/kg; group S3 sufentanil 0. 6 fig/kg. Baroreflex response was triggered by bolus intravenous injection of phenylephrine. The quantitative relationship between systolic arterial pressure and subsequent cardiac cycle lengths was evaluated as an index of reflex performance. BRS values were measured before and after fentanyl or sufentanil infusion. Results The BRS in group F3, group S2 and group S3 decreased by (34.1 ± 11. 0)%, (33. 5 ± 13. 0)%, (45. 0±15. 0)%, respectively(P<0. 05). Conclusion Fentanyl (>6 μg/kg) or sufentanil 00. 4 μg/kg) can decrease BRS in preoperative patients, and equipotent dose of sufentanil has a greater effect on BRS than that of fentanyl.