【摘要】 目的观察瑞芬太尼对不停跳心内直视手术患者血流动力学和应激反应的影响。方法ASA I~II级行房间隔缺损或室间隔缺损修补术患者20例,以咪唑安定0.1 mg/kg、丙泊酚1.5~2 mg/kg、维库溴铵0.12mg/kg、瑞芬太尼1~2μg/kg诱导插管,持续静脉输注瑞芬太尼0.05~0.1μg/(kg.min)同时丙泊酚4~8mg/(kg.h)泵入维持麻醉。分别记录诱导前(T1)、诱导后1min(T2)、插管后1min(T3)、插管后3min(T4)、插管后5 min(T5)、切皮(T6)、开胸后即刻(T7)、转流前(T8)、停机后10 min(T9)、关胸后(T10)SBP、DBP、MAP、HR及BIS值,同时采集10例患者诱导前、插管后5min、开胸后即刻、转流前、转流后15 min、停机后10 min各时点动脉血3mL,观察围麻醉期应激激素(ACTH、Cor)变化。结果血压在诱导后、插管后5 min及转流前与诱导前比较有统计学意义(P<0.05),HR在诱导后与诱导前比较有统计学意义(P<0.05);血压、HR与诱导后比较无统计学意义(P>0.05)。BIS值各时点与诱导前比较有统计学意义(P<0.05),各时点与诱导后比较无统计学意义(P>0.05)。转流前Cor与诱导前比较有统计学意义(P<0.05),ACTH及Cor在转流后15 min和停机后10 min与诱导前比较有高度统计学意义(P<0.01)。结论瑞芬太尼复合丙泊酚全凭静脉麻醉用于不停跳心内直视手术可以获得满意的血流动力学,但不能完全抑制应激激素的释放,作为快通道麻醉的用药还需加强完善。更多还原

【Abstract】 Objective To explore the effects of the stress response and hemodynamic changes with Infusion of remifentail-propofol for beating open heart surgeryanesthesia.Methods Twenty patients(ASA I～II)with atrial septal defect or eventricular septal defect were induced with midazolam(0.1mg/kg),propofol(1.5～2 mg/kg),vecuronium(0.12 mg/kg),remifentail(1～2μg/kg).All patients were administered remifentanil 0.05～0.1μg/(kg·min) and propofol 4～8mg/(kg·h)infusion to maintain anesthesia.SBP、DBP、MAP、HR and BIS were recorded before induction,1min after induction,1min、3min、5min after intubation,after incision and sternotomy,before CPB,10min end after CPB,closing chest.Meanwhile,blood samples were obtained before induction(T1),5 min after intubation(T2),immediately after sternotomy(T3),before CPB(T4),15 min after CPB(T5)and 10 min end after CPB(T6)from ten patients of those,observing the stress changing during general anesthesia.Results BP at 1min after induction,5min after intubation and before CPB which compared with before induction were significantly lower(P<0.05).there is a significant difference that HR after induction compared with before induction(P<0.05).BP and HR had not significant difference at each point after intubation compared with after induction.The maintenance of BIS was satistactory.There were statistically significant differences with ACTH and Cor at 15min after CPB,10min end of CPB compared with before induction(P<0.01).Conclusion Infusion of remifentail-propofol for beating open heart surgery anesthesia can offer hemodynamic stability.It is not enough effection to decrease stress response.But this way can reach the demend of fast track anesthesia.The administration of anesthesia should be improved during fast track anesthesia.更多还原