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|本期目录/Table of Contents|

先天性心脏病手术两种麻醉药物的比较

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2013年第2期
页码:
224-226229
栏目:
临床研究
出版日期:
2013-04-25

文章信息/Info

Title:
Comparison of two anesthetic drugs used in congenital heart surgery
作者:
袁 辉; 黄维勤; 祁 明
（武汉亚洲心脏病医院麻醉科，湖北 武汉 430022）
Author(s):
YUAN Hui;  HUANG Wei-qin;  QI Ming
(Department of Anesthesiology, Wuhan Asia Heart Hospital, Wuhan 430022, Hubei, China)
关键词:
舒芬太尼; 瑞芬太尼;  心脏快通道麻醉; 婴幼儿; 先天性心脏病
Keywords:
sufentanil;  remifentanil;  fast-track cardiac anesthesia;  neonates;  congenital heart disease
分类号:
R541.7
DOI:
-
文献标识码:
A
摘要:
目的:通过观察心内直视手术中，舒芬太尼或瑞芬太尼复合七氟烷快通道麻醉对婴幼儿血流动力学，及对术后拔管时间，术后躁动情况和ICU逗留时间的影响。方法： 2011年2月~2012年3月择期行单纯房间隔缺损或室间隔缺损修补术患儿132（男70，女62）例，年龄8个月～5岁,术前NYHA心功能Ⅰ～Ⅱ级。随机分为两组,舒芬太尼组（n=66）和瑞芬太尼组（n=66）。两组均用咪唑安定和维库溴铵诱导麻醉， 舒芬太尼组诱导用舒芬太尼1 μg/kg，术中维持持续泵入舒芬太尼2～2.5 μg/（kg·h）；瑞芬太尼组诱导用瑞芬太尼2 μg/kg，术中维持持续泵入瑞芬太尼0.1～1 μg/（kg·min）维持麻醉，两组均吸入七氟烷，持续泵入维库溴铵80～120 μg/（kg·h）。观察两组患者术前、术中、术后血流动力学变化，分别记录患儿闭眼入睡(基础,T0)、气管插管后(T1)、切皮(T2)、劈胸骨(T3)、开始转机(T4)、转机10 min(T5)、复温5 min(T6)、停机即刻(T7)、停机10 min(T8)、穿钢丝(T9)、手术结束(T10)和拔除气管插管时(T11)的心率（HR）、血压、脑电双频指数（BIS）及术后清醒时间、拔管时间、术后躁动情况和ICU逗留时间的影响。手术结束至拔除气管插管间时间为拔管时间。结果： 与T0 比较，两组患者T8、T9、 T10、T11 HR明显增快（P<0.05），T1、T5、T6、T8平均血压（MAP）下降（P<0.05））；苏醒情况：舒芬太尼组清醒时间、拔管时间较瑞芬太尼组长（P<0.01），瑞芬太尼组躁动发生率较舒芬太尼组高（P<0.05）。结论： 舒芬太尼或瑞芬尼复合七氟烷静吸复合麻醉用于婴幼儿单纯ASD或VSD等心内直视手术具有血流动力学稳定，能有效抑制应激反应，术后能早期拔管等特点，均能为婴幼儿先天性心脏病手术提供安全、快捷的快通道麻醉。
Abstract:
AIM:To evaluate the effect of fast-track anesthesia of sufentanil or remifentanil combined with sevoflurane on the intraoperative hemodynamics and postoperative recovery in congenital cardiac surgery in neonates. METHODS: From February 2011 to March 2012, 132 patients with simple congenital heart disease undergoing open heart surgery (simple ASD or VSD repair) were prospectively selected and randomly divided into the sufentanil group (n=66) and remifentanil group (n=66). Based on midazolam and vecuronium induction, induction and maintenance doses of sufentanil and remifentanil were 1 μg/kg and 2-2.5 μg/(kg·h) in sufentanil group and 2 μg/kg and 0.1-1 μg/(kg·min) in remifentanil group. Both groups inhaled sevoflurane, and the vecuronium maintenance dose was 80-120 μg/(kg·h). Data of heart rate, blood pressure, bispectral index, postoperative awake point and extubation time, postoperative consciousness state and length of stay in ICU were obtained and analyzed. RESULTS: No significant differences were found in gender, age, body weight, types of diseases, ASA classification, operation time and cardiopulmonary bypass (CPB) time between groups. Compared with that during sleep, the heart rate significantly increased (P<0.05) in the two groups at the time of 10-min weaning, sternal suturing, surgery completion and extubation. Mean blood pressure (MAP) decreased (P<0.05) after intubation, 10-min pumping, 5-min rewarming and 10-min weaning. Sufentanil group had a prolonged sober time and extubation time compared with remifentanil group (P<0.01), whereas the agitation incidence in the remifentanil group was higher (P<0.05). CONCLUSION: Fast-track anesthesia of sufentanil or remifentanil combined with sevoflurane for simple congenital heart disease surgery in neonates can effectively inhibit the stress response with stable hemodynamics and provide safe anesthesia for infants with congenital heart disease due to early postoperative extubation.

参考文献/References

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备注/Memo

备注/Memo:
收稿日期: 2012-07-29.通讯作者：祁明，主治医师，主要从事心血管病麻醉的研究 Email:taddy1875@hotmail.com 作者简介：袁辉，主治医师，硕士生 Email:yuanhui1979525@163.com
更新日期/Last Update: 2013-04-28