瑞芬太尼用于小儿先心病手术快通道麻醉应激反应观察  

Effect of remifentanil on stress responses in fast-track anesthesia in paediatric cardiac surgery

作　　者：刘佳[1] 董盛龙[2] 陈勇[1] 李娜[1] 

机构地区：[1]海南省人民医院麻醉科,海南海口570311 [2]海口市人民医院麻醉科,海南海口570208

出　　处：《海南医学》2015年第13期1915-1917,共3页Hainan Medical Journal

摘　　要：目的观察瑞芬太尼、小剂量芬太尼用于小儿先心病手术快通道麻醉对机体应激反应的影响。方法 30例择期房缺、室缺修补的小儿患者,随机分为瑞芬太尼组（R组）和芬太尼组（F组）各15例。两组患儿顺序给予咪达唑仑0.08 mg/kg、芬太尼4μg/kg、顺阿曲库铵0.15 mg/kg、依托咪酯0.3 mg/kg诱导气管插管;R组诱导后持续输注瑞芬太尼0.8-1.2μg/（kg·min）,手术结束后改为0.05-0.2μg/（kg·min）,拔管前10 min停药;F组分别于劈胸骨前、开始复温、关胸即刻分别注射芬太尼5μg/kg、5μg/kg和1.0μg/kg。诱导前（T0）、劈胸骨3 min（T1）、复温5 min（T2）、缝合胸骨3 min（T3）和拔除气管插管1 min（T4）时记录血压（MAP）和心率（HR）,同时测定肾上腺素（E）和血糖（BG）浓度。结果与T0时点比较,F组T1、T2、T3和T4时点的MAP明显升高（P〈0.05）,F组T1、T3和T4时点的HR明显升高（P〈0.05）;与F组比较,R组T4时点MAP、HR水平明显升高（P〈0.05）。与T0时点比较,F组T1、T2、T3和T4时点E水平均升高（P〈0.05）,F组T2、T3和T4时点BG水平均升高（P〈0.05）,R组T4时点E、BG水平升高（P〈0.05）;与F组比较,R组血浆E和BG在T2、T3和T4时点明显低（P〈0.05）。结论小儿先心病快通道手术,瑞芬太尼比芬太尼更能有效地抑制应激反应。Objective To observe the effects on stress response using remifentanil or a small dose of fentanyl for fast-track anesthesia in children of congenital heart disease undergoing cardiac surgery. Methods Thirty children of atrial defect, ventricular septal defect were randomly divided into two groups（n=15 each） and were anesthetized with remifentanil（group R） or a small dose of fentanyl（group F）. All the patients were sequentially given midazolam 0.08 mg/kg, fentanyl 4 μg/kg, cis-atracurium 0.15 mg/kg, etomidate 0.3 mg/kg for tracheal intubation. In group R, patients received continuous infusion of 0.8-1.2 μg/（kg·min） remifentanil after induction, and then 0.05-0.2 μg/（kg·min）after surgery, to withdrawal 10 min before extubation. In group F, patients received 10 μg/kg fentanyl before split sternum, 5 μ g/kg fentanyl before rewarming, 1 μ g/kg fentanyl before suturing the sternum. Mean artery pressure（MAP） and heart rate（HR） were recorded before induction（T0）, 3 min after sternotomy（T1）, 5 min after rewarming（T2）, 3 min after suturing sternum（T3） and 1 min after extubation（T4）. The simultaneous determination of epinephrine（E） and glucose（BG） concentration were also recorded. Results In group F, the MAP at T1, T2, T3 and T4was significantly higher than T0（P0.05）, and the HR at T1, T3, and T4 was significantly increased（P0.05）. Compared with the group F, the MAP and HR levels at T4 in group R were significantly increased（P0.05）. Comparison with T0, the E levels in group F at T1, T2, T3 and T4were significantly elevated（P0.05）, the BG levels in group F at T2, T3 and T4were significantly elevated（P0.05）, and the E, BG levels in group R at T4increased（P0.05）. Compared with the group F,E and BG levels in plasma in group R at T2, T3 and T4were significantly lower（P0.05）. Conclusion In fast-track anesthesia in paediatric cardiac surgery for children with congenital heart disease, remifentanil is more effective than fentanyl in stress

关 键 词：瑞芬太尼 芬太尼 快通道麻醉 应激反应 

分 类 号：R725.4[医药卫生—儿科]