舒芬太尼对心脏瓣膜置换术患者麻醉诱导期血液动力学的影响

Sufentanil effected patients hemodynamic for the induction of anesthesia in cardiac valve replacement surgery

目的观察舒芬太尼对心脏瓣膜置换术患者麻醉诱导期血液动力学的影响。方法心脏瓣膜置换手术患者20例,随机分为舒芬太尼组(S组,n=10)和芬太尼组(F组,n=10)。全麻诱导:咪唑安定0.1～0.3mg/kg,维库溴铵0.1～0.2mg/kg。S组使用舒芬太尼1μg/kg,F组使用芬太尼10μg/kg。血液动力学监测:心电Ⅱ导联示波,有创动静脉测压,放置6腔Swan-Ganz导管,采用美国Baxter-2型连续心排血量多功能监测仪,测定心脏指数(CI)和肺毛细血管嵌压(PCWP)。观察心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心脏指数(CI)和肺毛细血管嵌压(PCWP)。分别于麻醉诱导前(T1)、麻醉诱导后气管插管前(T2)、插管后1分钟(T3)、5分钟(T4)和10分钟(T5)记录观察指标。结果HR、MAP、CVP和PCWP两组变化趋势基本一致。麻醉诱导后及气管插管后部分时间S组HR和MAP低于F组(P<0.05或P<0.01),插管后S组CVP明显高于F组(P<0.05或P<0.01)。麻醉诱导或气管插管后,F组CI明显下降(P<0.05或P<0.01),S组均无明显变化。观察期间PCWP均无明显变化。结论舒芬太尼可安全的用于心脏瓣膜置换手术。

Objective To observe Sufentanil effecting on patients henodynamic for the induction anesthesia in cardiac valve replacement surgery. Methods 20 cases of cardiac valve replacement surgery, were randomly divided into two groups Sufentanil（S,n= 10） and Fentanyl（F,n= 10） Induction of anesthesia： Midazolam 0. 1 -0. 3 mg/kg, Veeuronium Bronmide 0. 1-0. 2mg/kg. using a group of Sufentanyl 1 μg/kg, another group using Fentanil 10μg/kg. Hemodynamie Monitoring ： Oscillographic lead ECG Ⅱ, invasive arteriovenous pressure. There were placed six cavity Swan-Ganz catheter. The United Stales Baxter-2 Continuous cardiac output monitoring Muhifunetion Monitor was used. Deterruination of cardiac index （CI） and pulmonary capillary wedge pressure （PCWP）. Observation indicators including heart rate （HR）,Mean arterial pressure （MAP）, central venous pressure （CVP）,cardiac index （CI） and pulmonary capillary wedge pressure （PCWP）. Respectively, before induction of anesthesia （T1）, after induction of anesthesia before tracheal intubation （T2）, one minute after intubation （T3）. five minutes （T4） and 10 minutes （T5） record index. Results HR and MAP, CVP, PCWP two changes essentially the same. After tracheal intubation and after induction of anesthesia parttime HR and MAP was below F group than S group （P〈0. 05 or P〈0.01 ）. CVP was significantly higher S group than F group after intubation （P〈0. 05 or P〈0.01 ）. There were no significant changes for PCWP during observe, After tracheal intubation or after induction of anesthesia. Group F C1 decreased significantly （P〈0.05 or P〈0.01）, S group did not change significantly. Conclusion Sufentanil can safe for heart valve replacement surgery.