舒芬太尼复合丙泊酚靶控输注快通道心脏麻醉对心脏手术患者血流动力学及心肌损伤的影响  

Effect of fast-track cardiac anesthesia using target-controlled infusion of sufentanil and propofol on hemodynamics and myocardial injury in patients undergoing cardiac surgery

作　　者：宋磊军 朱雅萍[1] 耿素娟 SONG Lei-jun;ZHU Ya-ping;GENG Su-juan(Department of Anesthesiology,the 7th People's Hospital of Zhengzhou,Zhengzhou 450000,Henan,CHINA)

机构地区：[1]郑州市第七人民医院麻醉科,河南郑州450000

出　　处：《海南医学》2021年第12期1571-1574,共4页Hainan Medical Journal

摘　　要：目的探讨舒芬太尼复合丙泊酚靶控输注快通道心脏麻醉对心脏手术患者血流动力学及心肌损伤的影响。方法选取2020年1~7月于郑州市第七人民医院诊治的105例风湿性心脏病患者作为研究对象,依据随机数表法将其分为观察组53例和对照组52例。两组患者均进行心脏瓣膜置换术,观察组应用舒芬太尼复合丙泊酚靶控输注快通道心脏麻醉,对照组应用芬太尼复合丙泊酚靶控输注快通道心脏麻醉。比较两组患者术后不同时间的心肌损伤标志物水平、血流动力学指标及术后恢复情况。结果两组患者术毕、术后6 h、24 h、48 h的肌酸激酶(CK-MB)、心型脂肪酸结合蛋白(H-FABP)及肌钙蛋白-Ⅰ(cTnⅠ)水平均较麻醉前明显升高,且观察组患者术毕、术后6 h、24 h的CK-MB明显低于对照组,术毕、术后6 h、24 h、48 h的H-FABP水平明显低于对照组,术后6 h、24 h、48 h的cTnⅠ水平明显低于对照组,差异均有统计学意义(P<0.05);观察组患者在气管插管后(T2)、切皮后(T3)时间点HR值明显低于对照组,麻醉诱导后(T1)时间点MAP值明显高于对照组,差异均有统计学意义(P<0.05);观察组患者定向力恢复时间、自主呼吸时间、拔管时间和睁眼时间明显短于对照组,差异均具有统计学意义(P<0.05);观察组患者硝酸甘油和多巴酚丁胺用量分别为(7.24±1.31)mg、(9.15±3.16)μg,明显少于对照组的(8.61±1.41)mg、(11.12±4.38)μg,差异均具有统计学意义(P<0.05)。结论应用舒芬太尼复合丙泊酚靶控输注快通道心脏麻醉可维持心脏手术患者血流动力学平稳,保护心肌细胞,促进术后恢复。Objective To investigate the effect of fast-track cardiac anesthesia(FTCA)using target-controlled infusion(TCI)of sufentanil and propofol on hemodynamics and myocardial injury in patients undergoing cardiac surgery.Methods A total of 105 patients with rheumatic heart disease who were admitted to the 7 thPeople’s Hospital of Zhengzhou during January and July 2020 were selected as the study objects.According to random number table method,they were divided into a treatment group(53 cases)and a control group(52 cases).Both groups underwent cardiac valve replacement.The treatment group applied FTCA using TCI of sufentanil and propofol,while the control group received fentanyl and propofol TCI for FTCA.The levels of myocardial injury markers at different time after surgery,as well as hemodynamic indexes and postoperative recovery,were compared between the two groups.Results The levels of creatine kinase-MB(CK-MB),heart-type fatty acid-binding protein(H-FABP)and troponin-Ⅰ(cTnⅠ)in the two groups were significantly increased at the end of surgery,6 h,24 h and 48 h after surgery than before anesthesia(P<0.05).The CK-MB levels at the end of surgery,6 h and 24 h after surgery were significantly lower in the treatment group than in the control group(P<0.05);the H-FABP levels at the end of surgery,6 h,24 h and 48 h after surgery were significantly lower in the treatment group than in the control group(P<0.05);and the cTnI levels at 6 h,24 h and 48 h after surgery were significantly lower in the treatment group than in the control group(P<0.05).The HR values at these time points,after tracheal intubation(T2)and skin incision(T3),were significantly lower in the treatment group than in the control group,while the MAP value after anesthesia induction(T1)time point was significantly higher in the treatment group than in the control group(all P<0.05).The time of orientation recovery,spontaneous breathing,extubation and eye-opening were significantly shorter in the treatment group than in the control group(P<0.05).The dosages

关 键 词：心脏手术 舒芬太尼 丙泊酚 靶控输注 血流动力学 心肌损伤 

分 类 号：R654.2[医药卫生—外科学]