瑞芬太尼和舒芬太尼在小儿先天性心脏病快通道麻醉的比较〔1〕

摘要

Objective:To evaluate the effects of remifentanil and sulfentanyl on hemodynamics,stress-reaetion and out-comes in pediatric undergoing fast-track cardiac anesthesia. Methods:All 120 patients with Atrial septal defect( ASD)and (or)Ventricular septal defect(VSD)were randomly assigned to group R with bolus infusion of 0. 16 μg·kg-1 ·min-1 emifentanil and group S with bolus infusion of 1 μg·kg-1 ·h-1 sulfentanyl. The perioperative heart rate and arterial pressure were recorded. Serum adrenocorticotrophic hormone( ACTH),cortisol( COR),glucose( BG)and lactate acid( LAC)levels were measured accordingly. Cases of postoperative agitation,cardiovascular active drugs uses after re-beat,sedatives and analgesic uses 24 hours after operation and postoperative recovery condition were observed. Results:No difference was found on the heart rate andarterial pressure intraoperative changes between two groups. During extubation the heart rate and arterial pressure rise higher in group R,and come down slower also(P﹤0. 01). Serum adrenocorticotrophic hormone(ACTH),cortisol(COR),glu-cose( BG)and lactate acid( LAC)increased gradually after induction in both groups and peaked at theend of operation,then fell back but slower in group R(P﹤0. 01). Extubation time was shorter in group R(P﹤0. 01). Although postoperative agita-tion rate was higher(P﹤0. 05),cases of postoperative sodium nitroprusside use and sedatives and analgesic uses 24 hours after operation were more in group R(P﹤0. 05),there was no difference on postoperative ICU stay and hospital stay between two groups,and the same as cases of postoperative reintubation and respiratory complication. Conclusion:There were equivalent perioperative hemodynamic stability and stress reaction control in pediatric undergoing fast-track cardiac anesthesia with small doses infusion of remifentanil and sulfentanyl,the postoperative prognosis was good,and extubation wasearlier in group R.%目的：观察静脉输注小剂量瑞芬太尼和舒芬太尼对小儿先天性心脏病麻醉血流动力学、应激反应和术后转归的影响。方法：将120例择期行房间隔缺损和（或）室间隔缺损修补术患儿随机分为R组和S组（分别持续输注瑞芬太尼0.16μg·kg-1·min-1，舒芬太尼1μg·kg-1·h-1。记录两组患儿围术期各时点血流动力学变化。在相应时点抽取动脉血检测促肾上腺皮质激素（ ACTH）、皮质醇（ COR）、血糖（ BG）和血乳酸浓度（ LAC）浓度。记录两组患儿术后躁动发生情况及术后恢复情况。记录两组患儿复跳后心血管活性药物及术后24 h内镇静镇痛药物的使用情况。结果：T0~T10时点两组患儿心率、血压变化趋势基本一致，T8时点R组患儿心率、血压均显著上升（ P﹤0.01）；两组患儿T2~T6时点动脉血ACTH、COR、BG和LAC浓度显著升高（P﹤0.01），在T6时点达到最高值，术后逐渐回落， R组较S组回落缓慢（P﹤0.01）；R组拔管时间显著短于S组（P﹤0.01），R组患儿术后发生躁动率高于S组（P﹤0.05）、术后硝普钠及术后24 h内镇静镇痛药物使用例数均多于S组（均P﹤0.05），两组患儿术后ICU停留时间、术后住院时间、再次插管率、肺部感染发生率均未见明显差异（ P﹥0.05）。结论：在小儿先天性心脏病麻醉中持续输注小剂量瑞芬太尼和舒芬太尼均能有效抑制应激反应，围术期血流动力学稳定，手术预后好，但前者术后拔管较早。