冠状动脉旁路移植术中舒芬太尼、芬太尼对血浆细胞因子和乳酸的影响

Comparison of the effects of sufentanil and fentanyl on cytokines and lactate in patients undergoing coronary artery bypass graft

目的：比较体外循环（CPB）冠状动脉旁路移植术中舒芬太尼和芬太尼麻醉对血浆细胞因子和乳酸的影响。方法：择期冠状动脉旁路移植术30例，随机分为舒芬太尼组（S组）和芬太尼组（F组），每组15例。S组诱导麻醉为舒芬太尼1．0μg·kg^-1，继以1．5～3．0μg·kg^-1·h^-1维持。F组诱导麻醉为芬太尼10μg·kg^-1，继以15～30μg·kg^-1·h^-1维持。分别于麻醉后切皮前（T1）、体外循环30min（T2）、开主动脉后30min（T3）、停CPB 1h（T4）、术后4h（T5）、术后24h（T6）采患者静脉血测定血浆IL-1β，IL-6，IL-10及乳酸浓度，并记录术中舒芬太尼或芬太尼的用量。结果：与T1相比，两组IL-1β，IL-6，IL-10和乳酸在CPB后均升高（P〈0．05，P〈0．01）；IL-1β于T2-T5时S组低于F组（P〈0．05，P〈0．01）；IL-6于T2～T5时S组低于F组（P〈0．05，P〈0．01）；IL-10于T3～T6时S组高于F组（P〈0．01）；乳酸于T3和T4时S组低于F组（P〈0．01）；术中芬太尼的用量约为舒芬术尼的8倍。结论：在同等效应下舒芬太尼调节机体炎性反应效能强于芬太尼，并可减少乳酸生成，用于冠状动脉旁路移植术要比芬太尼更为理想。

Objective： To compare the effects of sufentanil and fentanyl on plasma cytokines and lactate in patients undergoing coronary artery bypass graft during cardiopulmonary bypass （ CPB）. Methods ： Patients scheduled for coronary artery bypass graft （ASA Ⅱ -Ⅲ , n = 30） were randomly divided into 2 groups （n = 15, for each group）. Anesthesia was induced with either sufentanil （ 1.0 μg· kg^-1 and maintained with 1.5 - 3.0 mg·kg^-1·h^-1） or fentanyl （10 μg·kg^-1 and maintained with 15 -30 mg·kg^-1·h^-1）; the other drugs were same in two groups. Blood samples were taken for determination of plasma IL-1β, IL-6, IL-10 and lactate before skin incision （ T1 ） , at 30 min after start of CPB （ T2 ）, 30 min after aortic decamping （ T3 ）, 1 h after termination of CPB （ T4 ） , 4 h （T5 ） , and 24 h （ T6 ） after operation. Results ： The plasma levels of IL-1β, IL-6, IL-10 and lactate were significantly increased after CPB in both groups as compared with T1（P 〈 0.05, P 〈 0.01 ）. The levels of IL-1 β at T2- T5 , IL-6 at T2-T5 , lactate at T3-T4 were lower in sufentanil group than in fentanyl group （ P 〈 0. 05, P 〈 0. 01 ） ; whereas the levels of IL-10 were higher at T3-T6 in sufentanil group than in fentanyl group（P 〈0.01 ）. The dosage of fentanyl used during the operation was about 8 times of that of sufentanil. Conclusion： Sufentenil is more effective in attenuating the CPB-induced inflammatory response and ischemia reperfusion injury than fentanyl during the coronary artery bypass graft.