小儿心脏手术的快通道麻醉——芬太尼、舒芬太尼、瑞芬太尼的比较  

Comparison of Fentanyl, Sufentanil and Remifentanil for Fast-track Pediatric Cardiac Anesthesia

作　　者：黄悦[1] 杭燕南[2] 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心麻醉科,上海200127 [2]上海交通大学医学院附属仁济医院麻醉科,上海200001

出　　处：《麻醉与监护论坛》2006年第5期249-252,共4页Forum of Anesthesia and Monitoring

摘　　要：目的：比较芬太尼，舒苏太尼及瑞芬太尼用于先心病小儿心内直视手术快通道麻醉对患儿血流动力学，血浆应激激素水平及术后拔管等的影响。方法：60例先心病患儿，ASAⅠ-Ⅱ级，择期行房间隔缺损或单纯室间隔缺损修补术，随机分为3组：芬太尼组（F组）；术中分次静注芬太尼，舒芬太尼组（S组）；术中分次静注舒芬太尼，瑞芬太尼组（R组），瑞芬太尼静注诱导后，术中连续输注，所有患儿术前口服咪达唑仑，入室后按分组情况分别静注芬太尼类药以及咪达唑仑，维库溴铵诱导，面罩加压给氧后气管插管，桡动脉和颈内静脉分别穿刺置管，监测动脉压及中心静脉压。术中静脉持续输注维库溴铵，氧气（50%）-氧化亚氮（50%）-异氟醚（〈1%）吸入。机械通气采用压力控制通气模式，根据血气分析结果及呼气末二氧化碳分压调整呼吸参数，按患儿对手术刺激的反应调节芬太尼类药用量。在常温或浅低温下进行体外循环，体外转流开始前，三组均追加咪达唑仑并停止吸入氧化亚氮和异氟醚。关胸前10min开始用吗啡静脉连续输注。分别记录患儿基础、诱导后，插管后1，3，5min及切皮、开胸、体外转流开始前及结束，术毕时的HR，SBP，DBP及使用其他药物和不哀恳事件发生情况。每组选择10例患儿，分别于诱导后，插管后5min，开胸后5min ,体外转流开始前，术毕抽取静脉血，测定血浆肾上腺素和增甲肾上腺素浓度。结果：三组患儿年龄，体重，术中体外循环转流和手术时间第一般资料比较无统计学意义（P〉0.05），诱导后，SBP，DBP和HR都明显下降（P〈0.05）.术前血浆肾上腺素和去甲肾上腺素水平比较，差异无统计学意义（P〉0.05）.各时间点血浆肾上腺素和去甲肾上腺素水平的组间比较差异也无显著性（P〉0.05）,但是拔管时间R组（53±57min）和Objective： To compare the effects of fentanyl,sufentanil and remifantanil on hemedynamics, stress and emergence charactedstic, s undergoing fast-track cardiac surgery in children. Method, Sixty pediatric patients with atrial septal defect or slmpte ventricutar septal defect who were deemed suitable for fast track anesthetic management were randomly allocated into fentanyl-based （Group F ） , sufentanil-based （Group S ） . or remifentanil-based （Group R ） groups. All patients were premedicated with midazolam, and induced with fentanyl, sufentanil or remifentanil, respectively, added with midazolam and vecuronium. Following intubation, isoflurane and N2O was inhaled in all patients. Anesthesia was maintained with fentanyl or sufentanil interval injecban and rernifentanil infusion, respectively. Slood samples were obtained after induction, 5 min after intubation and starnotomy, immediately before cardiopulmonary bypass （CPB） and at the end of Surgery. The time of extubation, du ration of cardiac intensive care unit （ICU） stay and complications were recorded. Results： There were no demographic differences among groups. After induction. HR, SBP and DBP decreased similarly from baseline in all groups. Hemndynamic response to intubation, incision and sternctomy was stable and similar in all groups. Catecholamines were low in all groups during surgery. Estubation in Group S （56±48 min） and Group R （53±57 min） were eartier than that in Group F/116±34 min）. The reintubatlon Incidence and stays in ICU were similar among groups. Conclusion： We conclude that moderate dose of fentanyl, sufentanil and remifentaml can provide stable hemodynamics for fast-track cardiac surgery in elected padiatric patients. Remifentanll and sufentanil can provide earlier extubation than fentanyl.

关 键 词：苏太尼 舒芬太尼 瑞芬太尼 小儿 心脏快通道麻醉 

分 类 号：R614[医药卫生—麻醉学]