【摘要】 目的:观察舒芬太尼、瑞芬太尼、芬太尼用于全麻诱导对机体应激反应和血液动力学的影响。方法:60例择期全麻手术患者,根据诱导时辅用镇痛药物的不同,按随机、双盲方法分为舒芬太尼(S)组、瑞芬太尼(R)组和芬太尼(F)组。分别于诱导前(T,基础值)、插管前即刻(T0)、插管后1 min(T1)、3 min(T2)、5 min(T3)记录收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)、SpO2,并在各时点抽取静脉血,用高效液相色谱法测定血浆去甲肾上腺素(NE)和肾上腺素(E)的浓度。结果:T0时三组的MAP、HR和T时相比显著降低(P<0.05或P<0.01),且R组下降幅度高于F、S组。F组:T1时的MAP、HR明显高于T时,亦高于相同时点的R、S组(P<0.01),于T2、T3时刻恢复至基础水平。R组:T1时的MAP、HR与T时相比无统计学差异(P>0.05),但从T1到T3MAP、HR呈持续下降趋势,至T2、T3时已明显低于T时,有2例HR达55次/分。S组MAP、HR在T、T1、T2、T3时的比较,差异无统计学意义。NE和E浓度除F组在T1、T2时高于基础值(P<0.05或P<0.01),其余各时点间比较,差异无统计学意义(P>0.05)。结论:和芬太尼相比,瑞芬太尼和舒芬太尼均能有效抑制插管时应激反应,同时舒芬太尼更有利于血流动力学稳定。更多还原

【Abstract】 Objective: To compare the effects of sufentanil,remifentanil or fentanyl on hemodynamic and stress responses of patients during induction of general anesthesia.Methods: In a randomized,double-blind study, sixty ASA Ⅰ～Ⅱ patients undergoing elective abdominal surgery under general anesthesia were divided into sufentanil group（S,n=20）,remifentanil group（R,n=20） and fentanyl group（F,n=20）.SBP,DBP,MAP,HR and SpO₂ were recorded before induction of anesthesia（T,baseline）,immediately after tracheal intubation（T₀）,1,3 and 5minutes after intubation（T₁,T₂,T₃）.At the same time,plasma norepinephrine（NE） and epinephrine（E） were determined by high performance liquid chromatography.Results: The MAP and HR in three groups at T₀ were significantly lower than those at T,and decreased much greatly in group R than in group F and S.The MAP and HR in group F significantly increased at T₁ than T,and returned to baseline at T₂ and T₃.The MAP and HR in group R at T₁ were not significantly different from those at T,but gradually decreased;the levels at T₂,T₃ were significantly lower than at baseline and in group F or S.Compared with the baseline,the MAP and HR in group S at T₁,T₂,T₃ remained unchanged. In group R,there were two patients whose HR were under 55·min^-1.In group F,the plasma NE and E at T₁,T₂ were significantly higher than those at T. In group R and S,there were no significant changes in plasma NE and E,which were all within normal range.Conclusion: Both sufentanil and remifentanil effectively inhibit the stress response during induction of general anesthesia.At the same time,sufentanil has better hemodynamic stability.更多还原