不同剂量舒芬太尼诱导对房室缺修补术患儿血流动力学的影响  

Effect of Sufentanil on hemodynamics in children with ASD and VSD surgery during aneshesia induction

作　　者：覃英[1] 官英勇[2] 谭冠先[3] 唐培佳[2] 

机构地区：[1]右江民族医学院附属医院麻醉科,广西百色533000 [2]广西玉林市第一人民医院麻醉科,广西玉林537000 [3]广西医科大学附属医院麻醉科,广西南宁530000

出　　处：《中国医药导报》2015年第25期82-85,136,共5页China Medical Herald

摘　　要：目的探讨不同剂量舒芬太尼诱导对房室间隔缺损修补术患儿血流动力学的影响。方法选择2012年10月-2013年5月玉林市第一人民医院房室缺修补术患儿80例为研究对象，将其随机均分为四组，依次静注眯达唑仑0．1mg／kg，舒芬太尼（Ⅰ组0．6μg／kg，Ⅱ组0.8μg／kg，Ⅲ组1．0μg／kg，Ⅳ组1．2μg/kg），依托眯酯0．3mg／kg和罗库溴铵0．6mg／kg。记录诱导前（T0）、诱导后（T1）、插管后即刻（T2）、插管后2min（T3）、插管后5min（T4）、插管后10min（T5）各时点的收缩压、心率及诱导期间心血管不良事件的发生率。结果四组患儿的年龄、性别、体重、身高、美国麻醉医师协会分级、心功能、房室缺例数比较差异无统计学意义（P〉0．05）。T0时，四组患儿收缩压、心率比较。差异无统计学意义（P〉0．05）；T1时，Ⅳ组收缩压显著低于Ⅰ组、Ⅱ组、Ⅲ组，差异有统计学意义（P〈0．05）；T2时Ⅰ组、Ⅱ组收缩压、心率显著高于Ⅲ，组和Ⅳ组（P〈0．05）。与T0比较，T1时四组患儿收缩压、心率均显著减慢（P〈0．05）；T2时Ⅰ组、Ⅱ组收缩压升高（P〈0．05）；与T0时心率比较，Ⅰ组、Ⅱ组显著升高（P〈0．05），Ⅲ组无明显变化（P〉0．05），Ⅳ组仍显著降低∽〈0．05）。麻醉诱导后及气管插管后各时点BIS与T0比较均显著下降（P〈0．05），相同时点组间比较差异无统计学意义（P〉0．05）。诱导后Ⅳ组低血压、心动过缓的发生率显著高于Ⅰ、Ⅱ、Ⅲ组（P〈0．05），插管后Ⅰ、Ⅱ组高血压、心动过速的发生率显著高于Ⅲ、Ⅳ组（P〈0．05）。结论舒芬太尼1．0μg/kg全麻诱导时气管插管反应较小。Objective To evaluate the effects of different doses of Sufentanil on hemodynamie of children undergoing ASD and VSD surgery during anesthesia induction. Methods 80 children were randomly and equally allocated into four groups, Anesthesia was induced with intravenbus injection of Midazolam 0.1mg/kg, Sufentanil （group Ⅰ ： 0.6μg/kg, group Ⅱ：0.8 μg/kg, group Ⅲ： 1.0 μg/kg, group Ⅳ： 1.2 μg/kg）, Etomidate 0.3 mg/kg and Roeuronium 0.6 mg/kg. SBP, HR and cardiovascular events were recorded before induction of anesthesia （T0）, after induction of anesthesia （T1）, intubation （T2）, after intubation 2min （T3）, 5 min （T4） and 10 min （T5）. Results There were no significant difference in age, sex, weight, height, Classified by ASA, heart function and the number of patients with congenital heart disease between four groups （P 〉 0.05）. SBP was significantly lower in group Ⅳ compared to the other groups at T1 （P 〈 0.05）. SBP, HR in group Ⅰ and Ⅱ were significantly higher than those in group Ⅲ and Ⅳat T2 （P 〈 0.05）. Compared with To, SBP, HR in group Ⅰ, Ⅱ, Ⅲ and Ⅳ were lower at Ⅱ （P 〈 0.05）. Compared with To, SBP,HR was higher in group Ⅰ and Ⅱ （P 〈 0.05）, no significant difference in group Ⅲ （P 〉 0.05）, lower in group IV at T2 （P 〈 0.05）. Compared with To, the BIS was lower in four groups at T2, T3, T4 and T5 （P 〈 0.05）. And there was no significant difference in BIS comparison among groups at the same time. The incidence of hypotension and bradyarrhythmia at T1 was significantly higher in group IV than the other groups （P 〈 0.05）, and the incidence of hypertension and tachycardia at T3, T4 and T5 were higher in group Ⅰ and Ⅱ than in group Ⅲ and Ⅳ （P 〈 0.05）. Conclusion Sufentanil 1.0 μg/kg has least stress response during anesthesia induction.

关 键 词：舒芬太尼 房室缺修补术 血流动力学 

分 类 号：R730.53[医药卫生—肿瘤]