不同剂量舒芬太尼在心脏瓣膜置换术患者全身麻醉中的应用

摘要

Objective:To analyze the application value of different-dosage Sufentanil in general anesthesia of patients with heart valve replacement.Methods:A total of 105 patients with heart valve replacement were randomly divided into Fentanyl group (n =27)treated with Fentanyl 10 μg/kg and Sufentanil groups A,B and C (n =26 in each group) treated with Sufentanil 1.0 μg/kg,1.5 μg/kg and 2.0 μg/kg,respectively,combined with Vecuronium Bromide and Midazolam for induction of tracheal intubation.The heart rate (HR),systolic blood pressure (SBP),diastolic blood pressure (DBP) and mean arterial pressure (MAP) before anesthesia induction (T0),after anesthesia induction (T1),and 1 min (T2),3 min (T3),5 min (T4),and 10 min (T5) after intubation as well as the drug administration conditions for cardiovascular diseases during intubation were recorded,and the rate-pressure product (RPP) was calculated.Results:Compared with that at T1,heart rate (HR) increased evidently in Fentanyl group (P ＜ 0.01),but had no change in Sufentanil groups A,B and C at T2 (P ＞ 0.05).Compared with those at T1,systolic blood pressure (SBP),diastolic blood pressure (DBP) and mean arterial pressure (MAP) increased notably in Fentanyl group (P ＜0.01),which were also prominently higher than those in Sufentanil groups A,B and C at T2 and T3 (P ＜ 0.05 or P ＜ 0.01).In Sufentanil groups A,B and C,rate pressure product (RPP) decreased markedly at T 1 ～T5 than that at T0 (P ＜ 0.01),and was evidently higher than that in Fentanyl group at T2 (P ＜ 0.01).There was insignificant difference among 4 groups in blood glucose level at T0,T2 and T5 (P ＞ 0.05).During tracheal intubation,the ratio of patients using atropine was prominently lower in Sufentanil group A than that in Fentanyl group and Sufentanil group C (P＜ 0.0 l).Conclusion:Application of different-dosage Sufentanil can all effectively prevent the stress response during tracheal intubation for patients with heart valve replacement,in which Sufentanil 1.0 μg/kg is more stable in haemodynamics during tracheal intubation.%目的:分析不同剂量舒芬太尼在心脏瓣膜置换术患者全身麻醉中的应用价值.方法:将105例心脏瓣膜置换术患者随机分为芬太尼组(n=27)和舒芬太尼组(分A、B、C3组,每组各26例),分别予以芬太尼10 μg/kg、舒芬太尼1.0 μg/kg、1.5μg/kg和2.0 μg/kg联合维库溴铵、咪唑安定进行诱导插管.分别记录麻醉诱导前(T0)、麻醉诱导后(T1)和插管后1min(T2)、3 min(T3)、5 min(T4)、10 min(T5)时的HR、SBP、DBP和平均动脉压(MAP)以及插管期间心血管的用药情况,计算心率血压乘积(RPP).结果:与T1时比较,芬太尼组T2时HR明显升高(P＜0.01),但舒芬太尼A、B、C3组无明显变化.与T1时比较,芬太尼组T2、T3时SBP 、DBP及MAP明显高于舒芬太尼A、B、C3组(P＜0.05或P＜0.01).舒芬太尼3组T1～T5时RPP较T0时明显降低(p＜0.01),且T2时明显低于芬太尼组(P＜0.01).4组T0、T2、T5时血糖值比较无显著差异(P＞0.05).插管期间,舒芬太尼A组使用阿托品的例数明显少于芬太尼组和舒芬太尼C组(P＜0.01).结论:使用不同剂量的舒芬太尼均能有效预防心脏膜瓣置换患者插管期间的应激反应,其中舒芬太尼1.0 μg/kg在插管期间的血流动力学更加稳定.