摘要
目的:观察心脏换瓣术患者心肌酶的变化,比较常用剂量下芬太尼、舒芬太尼和瑞芬太尼的心肌保护程度。方法:选择心脏换瓣术患者36例随机分为三组(n=12):芬太尼组(F组)、舒芬太尼组(S组)和瑞芬太尼组(R组)。三组患者均用咪达唑仑、阿片类药、维库溴铵、丙泊酚全凭静脉麻醉;但三组患者麻醉诱导、维持及术后静脉镇痛的阿片类药分别为芬太尼、舒芬太尼和瑞芬太尼。分别于麻醉诱导前(T1),升主动脉开放后30min(T2),术毕时(T3),体外循环停止后6h(T4)和24h(T5)抽静脉血测cTnⅠ、CK-MB、LDH浓度。结果:与F组比较,S组和R组cTnI于T2、T3、T4和T5明显降低(P<0.01),S组和R组CK-MB于T3和T4明显低于F组(P<0.05),S组和R组LDH于T3、T4和T5明显低于F组(P<0.05)。结论:与常用剂量芬太尼比较,舒芬太尼和瑞芬太尼更能减轻心脏换瓣术患者的心肌损伤,且瑞芬太尼作用可能更强一些。
Objective To observe the change of myocardial enzymes in patients undergoing cardiac valve replacement and compare the effect of fentanil, sufentanil and remifentanil in myocardial protection with general dose. Methods Thirty-six patients were randomly divided into three groups （n = 12）： fentanil group （group F）, sufentanil group （group S） and remifentanil group （group R）. All the patients were used with total intravenous anesthesia. The anesthesia drugs were midazolam, opioid agonists, vecuronim and propofol.The different opioid drugs （fentanil, sufentanil and remifentanil）were used in each group for induction, maintenance and postoperative analgesia. Blood samples were taken before anesthesia（T1 ）, thirty minites after aortic declamping （T2）, the end of operation （T3）, 6 h （T4） and 24 h （T5） after CPB for determination of plasma concentration of troponinⅠ （cTnⅠ）. Results Compared to the group F, cTnⅠ decreased significantly in group S and group R at T2,T3,T4 and T5 （P 〈 0.01 ）, CK-MB decreased significantly in group S and group R at T3 and T4（P 〈 0.05）, LDH decreased significantly in group S and group R at T3, T4, T5 （P 〈 0.05）. Conclusion Compared with general doses of fentanil, sufentanil and remifentanil have better effect on lessening myocardial injury for patients who undergoing cardiac valve replacement, and remifentanil maybe has greater contribution to reduce myocardial injury than sufentanil.
出处
《实用医学杂志》
CAS
北大核心
2013年第8期1338-1340,共3页
The Journal of Practical Medicine
基金
海南省卫生厅科研基金资助项目(编号:琼卫2009-75)
关键词
芬太尼
舒芬太尼
瑞芬太尼
心脏瓣膜置换术
心肌损伤
Fentanil
Sufentanil
Remifentanil
Heart valve replacement surgery
Myocardial injury
