舒芬太尼和芬太尼对体外循环下先天性心脏病手术患儿血浆IL-6的影响  

Effects of Sulfentanyl and Fentanyl on the plasma of IL-6 in pediatric undergoing surgical repair of congenital cardiac defects with cardiopulmonary bypass

作　　者：姚倩娟[1] 张良彬[2] 何小京[3] 李琼灿[1] 

机构地区：[1]湖南省长沙市中心医院麻醉科,湖南长沙410008 [2]中南大学湘雅三医院麻醉科,湖南长沙410013 [3]中南大学湘雅二医院麻醉科,湖南长沙410011

出　　处：《中国现代医学杂志》2013年第24期75-78,共4页China Journal of Modern Medicine

摘　　要：目的比较舒芬太尼和芬太尼对体外循环下先天性心脏病手术患儿血浆IL-6的影响。方法择期拟在体外循环下行室缺修补术患儿24例，年龄2-6岁，随机分为舒芬太尼组（s组）和芬太尼组（F组）。麻醉诱导前静脉注射咪达唑仑0．1mg／kg，维库溴铵0．15mg／kg，舒芬太尼0．7μg／kg（S组）或芬太尼5μg／kg（F组），切皮前两组静脉注射维库溴铵0．08mg／kg、咪达唑仑0．05mg／kg，舒芬太尼0．7μg／kg（S组）或芬太尼5μg／kg（F组），劈胸骨前静脉注射舒芬太尼1．5μg／kg（S组）或芬太尼10μg／kg（F组），劈胸骨后静脉输注异丙酚6～9mg／kg·h，按需间断静脉注射维库溴铵（每次0．08mg／kg）维持麻醉。转流前体外循环机内加入咪达唑仑0．1mg／kg，S组静脉注射舒芬太尼1．5μg／kg；F组静脉注射芬太尼10μg／kg。于入室（T1）、麻醉诱导时（T2）、气管插管后1min（T3）、5min（T4）、10min（T5）、切皮后1min（T6）、劈胸骨后1min（T7）时记录MAP、HR。于T1、T3、T7、复温即刻（TR）、停CPB后10min（T9）术后24h（T10）时取桡动脉血5mL，采用放射免疫法测定血浆IL-6值。结果两组HIK和MAP均在正常范围内。与T，比较，两组血浆IL-6值在T4-6时均显著升高（P〈0．05），而s组血浆IL-6值明显降低（P〈0．05）。结论①舒芬太尼和芬太尼均可安全用于小儿心脏直视手术的麻醉。②与芬太尼相比，舒芬太尼能更有效抑制体外循环下先天性心脏病手术患儿血浆IL-6的升高。[ Objective ] To observe the effects of Sulfentanyl and Fentanyl on the plasma of IL-6 in pediatric un- dergoing surgical repair of congenital cardiac defects with cardiopulminary bypass. [ Methods ] Twenty-four pedi- atric patients aged 2-6 years undergoing surgical repair of congenital heart defect were randomized into 2 groups： group Sulfentany （S） and group Fentanyl （F）. Anesthesia was induced with Midazolam 0.1 mg/kg and Sulfentanil 0.7μg/kg （in group S） or Fentanyl 5μg/kg （in group F）. Tracheal intubation was facilitated with Vecuronium 0.15 mg/ kg. Anesthesia was maintained with Propofol infusion at 6-9 mg/kg/h and intermittent iv boluses of Midazolam, Ve- curonium and 3 doses of Sulfentanyl （0.7, 1.5, 1.5μg/kg） or Fentanyl （5, 10, 10μg/kg）. MAP,HR were recorded at the time of baseline （T1）, tracheal intubation （T2）, 1 min after tracheal intubation （T3）, 5 rain after tracheal intubation （T4）, 10 min after trachea/intubation （T5）, 1 rain after skin incision （T6）, 1 min after splitting of sternum （T7）. Arterialblood samples were taken before induction of anesthesia （baseline %）, at 1 min after tracheal intubation （T3）, 1 min after splitting of sternum （T7）, immediately after re-warmed （Ts）, 10 rain after termination of CPB （T9） and 24 h after operation （T7） for determination of plasma Interleukin-6. [ Results ] The MAP and HR were maintained in the noimal range during operation in both groups. The plasma concentrations of Interleukin-6 were significantly lower in group S than in group F. Plasma Interleukin-6 increased significantly during operation as compared with the baseline be- fore anesthesia in both groups. [ Conclusions ] Both Sufentanyl and Fentanyl can be safely used in pediatric heart surgery. Sufentanyl can inhibit IL-6 in pediatric patients more effectively during surgical repair of congenital cardiac defect performed under CPB.

关 键 词：舒芬太尼 心肺转流术 儿童 心脏缺损 IL-6 

分 类 号：R614.2[医药卫生—麻醉学]