阿芬太尼与芬太尼静吸复合全麻时对血流动力学的影响

Comparison of hemodynamic effects of intravenous alfentanil or fentanyl during combined general anesthesia in human

对比观察了阿芬太尼与芬太尼对血流动力学的影响。选择ＡＳＡⅠ～Ⅱ级成年患者３６例，随机分成阿芬太尼组（ＡＦ）和芬太尼组（Ｆ）。在诱导和维持时，ＡＦ组静脉泵入阿劳太尼４０μｇ／ｋｇ和每分钟１μｇ／ｋｇ，Ｆ组静脉泵入芬大尼 ４μｇ／ｋｇ和每分钟 ０．１μｇ／ｋｇ，皆吸入 ０．５％～１．５％安氟醚和氧，并辅助维库溴胺维持麻醉。观察入室、给药后１、３、５分钟、静脉注射维库澳铵、硫喷妥钠后、插管后１、５分钟、消毒、切皮、探查、关腹、拔管后１、３分钟的血压、心率变化及给药前后血浆血管紧张素Ⅱ和醛固酮的变化。实验结果发现，ＡＦ组与Ｆ组于各观察点之间均无显著性差异，各参数的变化趋势基本相似。由于阿芬太尼较芬大尼对交感神经系统抑制作用强，临床上血流动力学指标的变化更为稳定些，可以减轻但不能完全消除插管和拔管的应激反应。

In order to evaluate the effects of alfentanil(AF) and fentanyl (F) on hemodynamics, 36 adult patients,ASA grade Ⅰ to Ⅱ. scheduled for elective operations,were randomly allocated to intravenously receiving an initial dose of AF 40μg·kg-1 (group AF) or F 4μg· kg -1 (group F) during induction of anesthesia. 'Vecuronium (VEC)0. 1mg·kg-1 and sodium thiopental (ST) 5mg· kg-1 were injected intravenously for endotracheal Intubation in both groups. After Intubation,an intravenous infusion with AF at a rate of 1μg· kg-1·min-1 or F at 0. 1μg· kg-1·min-1 was given in group AF or F,separately. Anesthesia was maintained with combination of inhalation of enflurane 0. 5% 1. 5% and Intermittent intravenous bolus of VEC 0. 02-0. 03mg·kg-1 in either group. The mean blood pressures (MBP) and HRs were recorded,before induction. 1. 3 and 5 mins after initial bolus of AF or F,after intravenous VEC and ST, 1 and 5 mins after intubatlon,at operative sterilization, incision,abdominal exploration and closure, and 1 and 3 mins after extubation,respectively. The venous blood sanples were taken before induction and after AF or F with drawal,to measure plasma concentions of anglotention Ⅱ (Ag Ⅱ )and aldosterone (Aid). There were not significant differences in HR and MBP correspondingly between two groups (P>0. 05 ),and hemodynamic variations showed similal tendency in both groups. The levels of Ag Ⅱ and Aid in group AF did not differ from those in group F (P>0. 05),but in group F,level of Aid after F withdrawal was higher than that before induction (P<0. 05). So we suggest that AF and F can produce similar degree of depressive effect on hemodynamics during combined general anesthesia,by inhibiting sympathetic activity.