摘要
目的观察和比较瑞芬太尼与舒芬太尼两种镇痛维持方式在体外循环心脏手术期间对血流动力学及内分泌应激反应的影响。方法择期行体外循环心脏手术患者40例,ASAⅢ-Ⅳ级,随机分为瑞芬太尼TCI组(R组)及舒芬太尼间断静注组(S组)。麻醉诱导后R组给予瑞芬太尼TCI,效应室模式药物浓度为(6~8)ng/ml;S组间断给予舒芬太尼50μg/次。两组均以七氟烷维持BIS 40~50,苯磺顺阿曲库铵0.1 mg/h泵注维持肌松。两组分别抽取不同时间点静脉血5ml用于ACTH、Cor、C3a、IL-6、IL-10、TNF-α测定,并监测不同时间点血流动力学指标。结果 R组MAP(70±5) mmHg在CPB开始时显著高于S组(62±5) mmHg(P<0.05),R组MAP在此时波动小;拔管时间R组(187±102) min少于S组(298±157) min(P<0.05);R组ACTH较S组显著降低(P<0.05);R组在鱼精蛋白中和15 min后Cor、IL-6及TNF-α水平显著低于S组(P<0.05)。结论在体外循环心脏手术期间,与舒芬太尼间断静注相比,瑞芬太尼TCI使患者术中血流动力学更稳定,内分泌应激水平更低,并显著减少患者术后气管导管拔管时间。
AIM To observe and compare the effects of two analgesic methods of remifentanil or sufentanil on hemodynamics and endocrine stress response during cardio surgery with cardiopulmonary bypass(CPB). METHODS Forty patients undergoing elective cardiopulmonary bypass surgery, ASAⅢ-Ⅳ, were randomly divided into remifentanil TCI group(group R) and sufentanilbolus injection group(group S). After induction of anesthesia, the group R was treated with remifentanil TCI and the concentration of the drug in the effect mode was 6-8 ng/ml. The group S was intermittently given sufentanil 50 ug. In both groups, sevoflurane was used to maintain BIS 40-50 and cisatracuriumbesilate was used to maintain muscle relaxation. 5 ml of venous blood at different time points were collected for the determination of ACTH, Cor, C3a, IL-6, IL-10 and TNF-α, and hemodynamic indexes at different time points were monitored in both groups. RESULTS At the beginning of CPB, MAP in the group R was significantly higher than that in the group S(70 ± 5 mmhg vs. 62 ± 5 mmhg, P < 0.05), but MAP in the group R fluctuated less. The extubation time in group R was less than that in group S(187 ± 102 min vs. 298 ± 157 min, P < 0.05). ACTH in group R was significantly lower than that in group S(P < 0.05).After 15 minutes of protamine neutralization, the levels of Co, IL-6 and TNF-α in group R were significantly lower than those in group S(P < 0.05). CONCLUSION During cardiac surgery with cardiopulmonary bypass, compared with sufentanil bolus injection, remifentanil TCI stabilizes the patient’s intraoperative hemodynamics, lowers endocrine stress and significantly reduces postoperative tracheal extubation time.
作者
冯文秋
骆炜
肖昭扬
吴海波
FENG Wen-qiu;LUO Wei;XIAO Zhao-yang;WU Hai-bo(Department of Anesthesiology,Dalian Medical University,Dalian 116023,Liaoning,China;Department of Cardiac Surgery,Second Hospital,Dalian Medical University,Dalian 116023,Liaoning,China)
出处
《心脏杂志》
CAS
2021年第1期39-44,共6页
Chinese Heart Journal
基金
国家自然科学基金项目资助(81471373)。
关键词
舒芬太尼
瑞芬太尼
血流动力学
应激反应
体外循环
sufentanil
remifentanil
hemodynamics
stress response
cardiopulmonary bypass
