摘要
目的：探讨不同剂量舒芬太尼对心脏瓣膜置换术病人气管插管应激反应的影响,并与芬太尼进行比较。方法：将60例择期瓣膜置换术病人随机均分成芬太尼10μg/kg（A）、舒芬太尼1μg/kg（B）、舒芬太尼1.5μg/kg（C）与舒芬太尼2μg/kg（D）四组。分别给予芬太尼10μg/kg,舒芬太尼1μg/kg、舒芬太尼1.5μg/kg与舒芬太尼2μg/kg加咪唑安定、维库溴铵诱导插管。记录麻醉诱导前（T0）,麻醉诱导后（T1）,插管后1min（T2）、3min（T3）、5min（T4）、10min（T5）时收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）,并计算出相应的心率和收缩压乘积（RPP）。于T0、T2、T5各时间点抽血测定血糖。结果：四组病人T0时SBP,DBP,MAP,HR,RPP比较均无统计学差异（P〉0.05）;T1时上述参数与T0比较明显下降（P〈0.01）,但组间无差异（P〉0.05）。A组T2,T3时SBP,DBP,MAP较T1有所升高（P〈0.01～0.05）,但与T0比较无统计学差异（P〉0.05）;B,C,D三组SBP,MAP在T2,T3时低于A组（P〈0.01～0.05）,D组在T4时仍低于A组（P〈0.05）。A组在T2时HR较T1有所上升（P〈0.05）,但仍未达到T0水平,B,C,D三组在T2时HR较T1变化不大,T2时D组HR低于A组（P〈0.05）;T5时A,D组HR明显低于B组（P〈0.05）。B,C,D三组在T1直至T5时RPP均较T0明显降低（P〈0.01）,在T2时A组RPP高于B,C,D三组（P〈0.01）。A,B,C,D四组在诱导插管期间使用阿托品的例数分别为5（33.3%）,0（0%）,4（26.7%）,5（33.3%）,B组明显低于A,D两组（P〈0.05）。A,B,C,D四组各时间点血糖值变化无明显统计学意义（P〉0.05）。结论：三组剂量舒芬太尼均能有效抑制心脏瓣膜置换病人气管插管应激反应,其中1μg/kg组插管期间血流动力学更加稳定。
Objective To determine the effect of different doses of sufentanil on stress responses to tracheal intubation in patients undergoing heart valve replacement surgery. Methods Sixty patients undergoing heart valve replacement surgery were randomly divided into 4 groups （ n = 15 ）. Before the tracheal intubation, patients received 10 μg/kg fentanyl （Group A ）, 1 μg/kg sufentanil （Group B ）, 1.5 μg/kg sufentanil （Group C） , and 1.5 μg/kg sufentanil （Group D） , respectively, with midazolum and vecuronium intravenous injection. Systolic blood pressure （SBP）, diastolic blood pressure （DBP）, mean arterial pressure （MAP） , and heart rate （HR） were recorded before the induction of anesthesia （ T0 ） , after the induction of anesthesia （ T1 ） , and at 1 （ T2 ） , 3（T3 ） , 5 （T4 ） , and 10 min after the tracheal intubation （T5 ）. Rate-pressure product was derived from SBP and HR. Blood sugar was monitored at T0 , T2 and T5. Results The SBP, DBP, MAP, HR and RPP at T0were not significantly different among the 4 groups （ P 〉 0. 05 ）. These parameters at T1 were significantly lower than those at TO （ P 〈 0. 01 ） , but there was not significant difference among the 4 groups. The SBP, DBP, MAP in Group A increased significantly at T2 and T3 than those at T1 （ P 〈 0. 01 - 0. 05 ）, but were not significantly different than those at TO （ P 〉 0. 05 ）. The SBP, MAP in Group B, C, D at T2 and T3 were significantly lower than those in Group A （ P 〈 0.01 -0.05 ）. The SBP and MAP in Group D at T4 were still lower than those in Group A （P〈 0.05）. The HR at T2 in Group A increased compared with that at T1（P 〈0.05）,but was still lower than that at T0. The HR at T2 in Group B, C, and D was not significantly changed. The HR decreased significantly at T2 in Group D compared with that in Group A （ P 〈 0. 05 ） , and the HR at T5 in Group A and D significantly decreased compared with that in Group B （ P 〈 0. 05 ）. The RPP at T1 to T5 in Group B, C, and D significantly decreased compared with that at T0 （ P 〈 0. 01 ）. The RPP at T2 in Group A increased significantly compared with those in Group B, C, and D （P 〈 0. 01 ）. The cases of using atropine during the induction and intubation in Group A, B, C, and D were 5（33.3%）,0（0%）,4（26.7%）,5（33. 3%）,respectively, and the cases in Group B were significantly different compared with those in Group A and D （ P 〈 0. 05 ）. The change of blood sugar in Group A, B, C, and D was not significantly different （ P 〉 0. 05 ）. Conclusion Three doses of sufentanil may effectively control the stress responses to the tracheal intubation in patients undergoing heart valve replacement surgery, and the hemodynamics during the intubation at 1 μg/kg is much more stable.
出处
《中南大学学报（医学版）》
CAS
CSCD
北大核心
2007年第3期507-511,共5页
Journal of Central South University ：Medical Science
