摘要
目的 比较舒芬太尼和芬太尼复合麻醉下体外循环（CPB）先天性心脏病手术患儿的应激反应。方法择期拟在体外循环下行先天性心脏病手术患儿24例，年龄2—6岁，随机分为2组（n=12）：舒芬太尼复合麻醉组（S组）和芬太尼复合麻醉组（F组）。静脉注射咪达唑仑0．1mg／kg，维库溴铵0．15mg／kg，舒芬太尼0．7μg／kg（S组）或芬太尼5μg／kg（F组），气管插管后机械通气，切皮前两组静脉注射维库溴铵0．08mg／kg、咪达唑仑0．05mg／kg、舒芬太尼0．7μg／kg（s组）或芬太尼5μg／kg（F组），劈胸骨前静脉注射舒芬太尼1．5μg／kg（S组）或芬太尼10μg／kg（F组），劈胸骨后静脉输注异丙酚6～9mg·kg^-1·h^-1，按需间断静脉注射维库溴铵0．08mg／kg维持麻醉。转流前体外循环机内加入咪达唑仑0．1mg／kg，S组静脉注射舒芬太尼1．5μg／kg，F组静脉注射芬太尼10μg／kg。于入室（E）、麻醉诱导前即刻（T2）、气管插管后1min（T1）、5min（T4）、10min（L）、切皮后1min（T6）、劈胸骨后1min（L）时记录MAP、HR。于T1、T3、T7、复温即刻（L）、停CPB后10min（T9）、术后24h（T10）时抽取桡动脉血样5ml，测定血浆促肾上腺皮质激素、皮质醇、胰高血糖素、乳酸、血糖浓度。结果两组MAP和HR均在正常范围内。与F组比较，S组血浆促肾上腺皮质激素、皮质醇、胰高血糖素和乳酸浓度降低（P〈0．05或0．01），血糖浓度差异无统计学意义（P〉0．05）。与T1时比较，两组T7-10时血浆促肾上腺皮质激素、胰高血糖素和血糖浓度升高，T7,9,10时皮质醇浓度升高，T8-10时乳酸浓度升高（P〈0．05）。结论与芬太尼复合麻醉相比，舒芬太尼复合麻醉可更有效地抑制体外循环先天性心脏病手术患儿应激反应。
Objective To compare the effects of sufentanil and fentanyl combined anesthesia on stress responses in pediatric patients undergoing surgical repair of congenital heart defect with cardiopulmonary bypass （CPB） . Methods Twenty-four pediatric patients aged 2-6 yr undergoing surgical repair of congenital heart defect were randomized into 2 groups （n = 12 each）： sufentanil combined anesthesia group （group S） and fetanyl combined anesthesia group （group F） . The patients were premedicated with intramuscular morphine 0.2 mg/kg, scopolamine 0.01 mg/kg and ketamine 5 mg/kg. Anesthesia was induced with midazolam 0.1 mg/kg and sufentanil 0.7 μg/kg （in group S） or fentanyl 5 μg/kg （in group F）. Tracheal intubation was facilitated with vecuronium 0.15 mg/kg. The patients were mechanically ventilated. PETCO2 was maintained at 35-45 mm Hg. Anesthesia was maintained with propofol infusion at 6-9 mg· kg^-1· h^-1 and intermittent iv boluses of midazolam, vecuronium and 3 doses of sufentanil （0.7, 1.5, 1.5 μg/kg） or fentanyl （5, 10, 10 μg/kg）. Arterial blood samples were taken after entering the operation room, at 1 min after tracheal intubation, 1 min after splitting of sternum, immediately after rewarming, 10 min after termination of CPB and 24 h after operation for determination of plasma ACTH, cortisol, glucagon, lactic acid and blood glucose.Results The MAP and HR were maintained in the normal range during operation in both groups. The plasma concentrations of ACTH, cortisol, glucaon and lactic acid were significantly lower in group S than in group F. Plasma ACTH cortisol, glucagon, lactic acid and blood glucose increased significandy during operation as compared with the baseline before anesthesia in both groups. Conclusion Sufentanil combined anesthesia can inhibit stress response in pediatric patients more effectively during surgical repair of congenital cardiac defect performed under CPB.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2009年第10期881-884,共4页
Chinese Journal of Anesthesiology
