瑞芬太尼与小剂量芬太尼用于小儿先心病手术快通道麻醉的对比研究  

Comparison between Remifentanil and Small Dose Fentanyl Used in Fast Track Cardiac Anesthesia for Pediatric

作　　者：崔林[1] 刘丹丹[1] 

机构地区：[1]哈尔滨医科大学附属第一医院,黑龙江哈尔滨150001

出　　处：《黑龙江医学》2011年第5期325-327,共3页Heilongjiang Medical Journal

摘　　要：目的对比瑞芬太尼和小剂量芬太尼用于小儿先心病手术快通道麻醉的效果。方法对年龄2～12岁拟在体外循环下行房缺或室缺修补术患儿24例,根据阿片药物用药的不同随机分为两组,R组(n=12)为瑞芬太尼麻醉,F组(n=12)为小剂量芬太尼麻醉。分别记录两组入室(T0)、诱导(T1)、锯胸骨(T2)、缝合胸骨(T3)、手术结束(T4)各时刻的血流动力学以及血糖变化。术毕,记录拔管时间和ICU停留时间以及术后疼痛情况进行比较。结果两组的血压和心率在T1、T2较T0明显下降。R组的心率在T1时下降更明显。与T0相比,两组患儿血糖在T3、T4明显增高,T3时组间差异明显。两组在苏醒时间、拔管时间、ICU停留时间情况上差异无显著性。在术后镇痛方面,小剂量芬太尼组效果好于瑞芬太尼组。结论小剂量芬太尼与瑞芬太尼都可以用于小儿快通道麻醉。瑞芬太尼能更好的抑制体外循环初期所引起的应激反应,但会导致心率减慢。小剂量芬太尼麻醉方法能够提供更好的术后镇痛。Objective To compare the effects of remifentanil and small dose of fentanyl in pediatric undergoing surgical repair of congenital cardiac defects.Methods Twenty-four pediatric underwent elective surgery repair of congenital cardiac defects were divided into two groups randomly.The patient were anesthetized with remifentanil（group R） or fentanyl（group F）.The changes of MAP,HR were observed during anesthesia when getting into the operating room（T0）,induction of anesthesia（T1）,spliting the sternum（T2）,suturing the sternum（T3）,the surgery was finished（T4）.Recorded the time of disturbe,discharge from ICU and the condition of analgesia.Results The MAP and HR in two groups were significant lower at T1、T2 than T0.The HR in group R was significant lower than those in group F at T1.The Glu of the two groups was significant increased at T3、T4 than T0,The Glu in group F was significantly higher than those in group R at T3.There was no significantly different in the time of disturbe and discharge from ICU among the two groups.The condition of analgesia in group F was better than group R.Conclusion Both remifentanil and small dose of fentanyl could be safely used in pediatric heart surgery.Remifentanil could control the stress hormone better at the beginning of CPB than fentanyl,but with more slowly HR.The small dose of fentanyl could make better analgesia.

关 键 词：瑞芬太尼 芬太尼 小儿先心病 

分 类 号：R614.2[医药卫生—麻醉学]