舒芬太尼复合丙泊酚阶梯式靶控输注对老年患者应激反应的影响  

Effect of sulfentanyl combined target controlled infusion of propofol on stress reaction during operation in elderly patients

作　　者：王海滨[1] 郎淑慧[1] 张冬梅[1] 郑月梅[1] 杨莉[1] 

机构地区：[1]宁夏医科大学附属医院,宁夏银川750004

出　　处：《宁夏医学杂志》2011年第10期958-961,共4页Ningxia Medical Journal

基　　金：宁夏医科大学校级项目(XZ200806)

摘　　要：目的比较等效剂量芬太尼和舒芬太尼复合丙泊酚阶梯式靶控输注对老年患者围手术期血流动力学、应激反应的影响。方法 40例年龄在60岁以上全麻下行腹部手术的老年患者,ASAⅠ-Ⅱ级,分为芬太尼组(F组,n=20)和舒芬太尼组(S组,n=20)。均复合丙泊酚阶梯式靶控输注全凭静脉麻醉,记录两组麻醉诱导前(T0)、气管插管前(T1)、气管插管后3min(T2)、切皮后即刻(T3)、切皮后1h(T4)、术毕(T5)血压和心率,术后睁眼及拔管时间,疼痛视觉模拟评分(VAS评分),并检测诱导前后不同时间皮质醇和血糖。结果两组患者不同时点HR、SBP组间比较差异无统计学意义(P>0.05),仅DBP、MAP在T1时点F组低于S组(P<0.05);两组HR仅T3时点及SBP、DBP、MAP在T1、T2、T3时点与T0比较差异有统计学意义(P<0.05)。各时点的皮质醇、血糖组间比较差异无统计学意义(P>0.05);但与诱导前比较F组皮质醇、血糖均有升高(P<0.05),S组仅皮质醇在术毕的时间点、血糖各时点与诱导前比较升高明显(P<0.05)。两组患者术后睁眼和拔管时间、术后VAS评分S组明显低于F组(P<0.05)。结论舒芬太尼复合丙泊酚靶控输注较等效剂量的芬太尼更利于维持老年患者围手术期血流动力学稳定,且对应激反应有一定抑制作用。Objective To compare the effect of fentanyl and sulfentanyl combined target controlled infusion of propofol on stress reaction and hemodynamics during operation in elderly patients.Methods Forty elderly patients（60 year-old,ASA I-II） undergoing selective surgery were divided into fentanyl（group F,n=20） and sufentanil（group S,n=20）,and both groups was used step-by-step target controlled infusion（TCI） of propofol.The blood pressure（BP） and heart rate（HR） were recorded before anesthesia induction（T0）,before intubation（T1）,3min after tracheal intubation（T2）,the beginning of operation（T3）,one hour after the beginning of operation（T4） and the end of operation（T5）.The time to opening eyes and extubating,and visual analogue scale（VAS） were also recorded.The concentration of cortisol（Cor） and blood glucose（BG） was detected.Results The HR and SBP had no significant difference at different time point between groups（P0.05）.The DBP and MAP was lower in group F than those in group S at T1（P0.05）.Compared with the T0,the HR had statistical difference at T3 and the SBP,DBP,MAP had statistical difference at T1,T2 and T3（P0.05）.The Cor and BG had no significant difference at each time point between groups（P0.05）.But the Cor and BG in group F were obviously elevated than that before induction（P0.05）.In group S,the Cor at the end of operation and BG at each time point were increased than those before induction（P0.05）.Time of opening eyes,extubation and the VAS had statistical difference between groups（P0.05）.Conclusion Compared with the equivalent doses of fentanyl,sufentanil combined propofol target-controlled infusion is more conducive to the maintenance of perioperative hemodynamic stability in elderly patients,and inhibits stress reaction for a certain extent.

关 键 词：芬太尼 舒芬太尼 老年患者 应激反应 

分 类 号：R614[医药卫生—麻醉学]