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等剂量舒芬太尼和芬太尼用于冠脉搭桥手术麻醉的比较
| A Comparison of Equal Dose Sufentanil and Fentanyl in Coronary Artery Bypass Grafting Anesthesia. Jiang-dong Gao, An-shi Wu, Yun Yue Department of Anesthesiology, Chaoyang Hospital, Capital Medical University, Beijing 100020, China ABSTRACT Objective: To compare the effects of equal dose sufentanil with fentanyl in coronary artery bypass grafting anesthesia. Method: thirty-five patients scheduled for coronary artery bypass grafting were randomly divided into two groups, group sufentanil (S) and group fentanyl (F). Before one hour of operation all the patients orally diazepam 10mg and scopolamine 0.3mg IM and morphine10mg IM. Anesthesia were inducted with midazolam 0.03mg/kg，pipecuronium 0.15mg/kg. Sufentanil 5ug/kg in S group and fentanyl 5ug/kg in F group was given intravenously after pipecuronium. Anesthesia was maintained with propofol continuous infusion. Sufentanil 5ug/kg in S group and fentanyl 5ug/kg in F group was added before incision and sternum splitting. Midazolam was given before incision and sternum splitting if needed. Dopamine and isosorbide were continuous infused during operation in both groups. When blood pressure decreased more than 30% of baseline and HR less than 45 /min, phenylephrine and 654-2 were given . MAP, HR, CVP, MPAP, CCO, SVO2, CI, SVR, PVR, PCWP were measured by Edwards Vigilance Monitor. The dosage of narcotic, the time of extubation and the degree of sedation were recorded。 Results：HR and MAP in two group were decreased significantly after induction（P<0.05）. MAP in group F were increased significantly over baseline（P<0.01）after incision and before sternum splitting, but in group S there were no different than before anesthesia（P>0.05）. Before grafting HR in two group was increased significantly than before incision（P<0.05），and there was no different between two groups（P>0.05）. CO and CI in group S increased significantly more than that in group F（P<0.05）. SVR in group S decreased significantly than group F（P<0.01）. The dosages of dopamine, isosorbide, phenylephrine and 654-2 were no significantly different between two groups. But propofol and midazolam in group S were significantly less than group F （P<0.01）. The degree of sedation in group S was deeper than group F（P<0.01）。 Conclusion：Equal dosage of sufentanil is superior to the fentanyl in coronary artery bypass grafting anesthesia. It not only can reduced the dosage of narcotic in the operation，but also keep hemodynamics more stable, increase the degree of sedation after operation than fentanyl without influence to the time of intubation。 Keywords: Sufentanil; Fentanyl; Hemodynamics; Anesthesia; Coronary artery bypass grafting Corresponding author: Jian-dong Gao；E-mail: jiandongdr@126.com 芬太尼的N-4噻芬基衍生物舒芬太尼是一种强效拟吗啡类镇痛药，镇痛效价是芬太尼的10倍，并具有起效快、心血管系统功能稳定无组胺释放等优点[1][2]。大剂量的舒芬太尼（8-50ug/kg）用于心脏和胸科等大型手术麻醉已有很多报道[3]，但对于等剂量（10ug/kg）的舒芬太尼和芬太尼用于冠脉搭桥病人的报道并不多。本研究旨在比较等剂量（10ug/kg）的舒芬太尼和芬太尼用于冠脉搭桥病人手术中血流动力学变化情况及术后拔管时间和镇静程度。 资料与方法 结 果 一般情况麻醉越深，心肌抑制作用越强，但搭桥后CO及CI较术前 S组升高的比F组明显，且两组间有明显的统计学差异（P<0.01），这可能与舒芬太尼降低血管阻力，降低前负荷明显有关；其次舒芬太尼对心肌的抑制作用较芬太尼更轻[5]；再有可能是因为舒芬太尼组镇痛效应较强[6]，不仅可以减少其它麻醉药对心血管的抑制作用，而且可以减少血流动力学的波动。 参 考 文 献 |
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