【摘要】 目的比较舒芬太尼和芬太尼用于小儿先天性心脏病手术麻醉中对血流动力学的影响.方法选择60例择期体外循环下行先天性心脏病矫治术患儿,随机分为舒芬太尼组(S组,n=30)和芬太尼组(F组,n=30).麻醉诱导:静脉注射咪达唑仑0.1～0.2 mg/kg,维库溴铵0.1 mg/kg,S组静脉注射舒芬太尼0.7μg/kg,F组静脉注射芬太尼7μg/kg,气管插管后机械通气.麻醉维持:间断静脉注射咪达唑仑0.1 mg/kg、维库溴铵0.1mg/kg、间断吸入七氟烷,分别在切皮前、转流开始前S组静脉注射舒芬太尼0.7μg/kg、F组静脉注射芬太尼7μg/kg.分别记录麻醉诱导前(T)0、诱导后(T)1、插管后(T)2、切皮后(T)3、锯胸骨后(T)4、术毕时(T)5各时点的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR),手术结束后统计手术时间、体外循环转流(CPB)时间、主动脉阻断时间、阿片类药物的用量.结果 2组患者在诱导后(T)1及插管后(T)2的SBP、DBP、MAP较诱导前(T)0明显下降,组间比较差异有统计学意义(P<0.01),心率较诱导前下降,组间比较差异无统计学意义(P>0.05);在诱导后(T)1及插管后(T)2 S组的SBP、DBP、MAP及HR较基础值的变化差异无统计学意义(P>0.05);而F组在SBP、DBP、MAP及HR均较基础值明显下降,差异有统计学意义(P<0.01).结论舒芬太尼应用于小儿先天性心脏病手术麻醉安全有效,与等效剂量芬太尼相比,有更好的循环稳定性.更多还原

【Abstract】 Objective To compare the effects of sufentanil and fentanyl on hemodynamics of pediatric patients undergoing congenital cardiac repair.Methods Sixty children scheduled for elective surgery of congenital cardiac defects was selected.Patients were randomly divided into two groups: sufentanil group(Group S,n=30) and fentanyl group(Group F,n=30).Anesthesia was induced with midazolam 0.1～0.2 mg/kg,vecuronium 0.1 mg/kg and sufentanil 0.7 μg/kg(in group S) / fentanyl 7 μg/kg(in group F),and maintained with intermittent iv boluses of midazolam and vecuronium,inhale sevoflurane,and then pre-incision and pre-cardiopulmonary bypass(CPB) sufentanil 0.7 μg/kg(in group S) /fentanyl7 μg/kg(in group F) was injected intravenously again.The patients were mechanically ventilated after tracheal intubation.SBP,DBP,MAP and HR were recorded before anesthesia induction(T 0),after anesthesia induction(T 1),after tracheal intubation(T 2),after skin incision(T 3),after sternal saw(T 4),the end of operation(T 5).Operation duration,cardiopulmonary bypass time,aortic cross-clamping time and the dose of sufentanil and fentanyl were recorded.Results Compared with T0,SBP,DBP and MAP of patients in two groups decreased(P<0.01),there was significant difference between two groups(P<0.01),HR also decreased(P<0.01),whereas there was no significant difference between two groups(P<0.01);Compared with T0,SBP,DBP,MAP and HR decreased at T1 and T 2 but there was no significant difference in group S.Compared with T 0,SBP,DBP,MAP and HR at T 1 and T 2 but there was significant difference in group F.Conclusion Sufentanil can be safely used in children undergoing heart surgery,and has less changes in hemodynamics than equivalent dose of fentanyl.更多还原