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目的比较舒芬太尼和芬太尼在先天性心脏病手术中的血流动力学及应激激素变化。方法 64例择期体外循环下行房室缺修补术患儿随机均分为舒芬太尼组(S组)和芬太尼组(F组),每组32例。分别记录入室时(T1)、麻醉诱导后(T2)、气管插管后2 mins(T3)、劈胸骨后1 mins(T4)、主动脉阻断开放后(T5)的平均动脉压(MAP)、心率(HR)的变化,并测定各时点血浆肾上腺素(E)和去甲肾上腺素(NE)。结果 T3、T4时HR S组(119.6±7.2)次/min、(114.7±8.5)次/min,F组(129.4±8.6)次/min、(124.0±7.5)次/min;T3、T4时MAP S组(89.7±8.2)mm Hg、(91.1±5.7)mm Hg,T3、T4时MAP F组(96.2±6.2)mm Hg、(97.4±6.5)mm Hg;T1、T4、T5NE浓度S组(0.442±0.123)、(0.438±0.123)、(0.578±0.324)ng/dl,T1、T4、T5NE浓度F组(0.449±0.135)、(0.497±0.184)、(0.625±0.311)ng/dl。结论舒芬太尼对小儿先天性心脏病手术的心血管系统有更好地稳定作用,手术刺激引起的激素变化更小。
Objective To compare the hemodynamic and stress hormone changes of sufentanil and fentanyl during congenital heart surgery. Methods Sixty-four patients undergoing elective cardiopulmonary bypass with atrioventricular node were randomly divided into sufentanil group (S group) and fentanyl group (F group), 32 in each group. The mean arterial pressure (MAP) at entry (T1), after induction of anesthesia (T2), 2 mins after endotracheal intubation (T3), 1 mins after split sternum (T4) , Heart rate (HR) changes, and determination of plasma levels of epinephrine (E) and norepinephrine (NE) at each time point. Results HR T3 (119.6 ± 7.2) times / min, (114.7 ± 8.5) times / min HR in T3 and T4, 129.4 ± 8.6 times / min in F group and (124.0 ± 7.5) times / min in T3 and T4; MAP (89.7 ± 8.2) mm Hg, (91.1 ± 5.7) mm Hg in MAP S group, (96.2 ± 6.2) mm Hg in MAP F group and (97.4 ± 6.5) mm Hg in T3 and T4 group; (0.442 ± 0.123), (0.438 ± 0.123) and (0.578 ± 0.324) ng / dl, respectively. The concentrations of T1, T4 and T5NE in group F were 0.449 ± 0.135, 0.497 ± 0.184 and 0.625 ± 0.311 ng / dl, respectively. Conclusion Sufentanil has a better stabilizing effect on the cardiovascular system of children with congenital heart disease surgery, and the hormonal changes induced by surgical stimulation are smaller.