舒芬太尼在小儿心脏手术中的临床应用

Sulfentanyl in children undergoing open heart surgery

目的观察舒芬太尼用于先天性心脏病手术患儿的血流动力学及应激激素变化。方法48例择期体外循环下行室缺修补术患儿随机均分为舒芬太尼组(S组)和芬太尼组(F组)。分别记录入室时(t0)、诱导后(t1)、插管后1 min(t2)、5 min(t3)、10 min(t4),切皮后1 min(t5),劈胸骨后1 min(t6)等时间点心率(HR)、平均动脉压(MAP),另分别于入室后(T0)、气管插管后(T1)、劈胸骨后(T2)、复温时(T3)、停CPB后10 min(T4)、术毕24 h(T5)抽动脉血观察血浆皮质醇(Cortisol,Cor)及促肾上腺皮质激素(ACTH)反应。结果①S组的血压在t3时明显较F组低(P<0.05),心率在t2、t3比F组的值要明显降低(P<0.05);②2组皮质醇在T2、T4、T5时显著升高(P<0.05),S组皮质醇在T4、T5时明显低于F组(P<0.05);2组ACTH在T1-5时显著升高(P<0.05),S组ACTH在T2、T4、T5时明显低于F组(P<0.05)。结论舒芬太尼用于体外循环心脏直视手术具有更稳定的心血管系统功能,对手术应激引起的激素变化更小。

Objective To explore the effect of sulfentanyl on hemodynamics and stress hormone in pediatric patients undergoing surgical repair of congenital cardiac defects. Methods Forty-eight pediatric patients were divided into group S and group F. Heart rate and mean arterial pressure were recorded during anesthesia before going into the operating room （t0）, induction of anesthesia （t1）, t min after the tracheal intubation （h）, 5 min after the tracheal intubation （t3）, 10 min after the tracheal intubation （t4 ） , 1 min after cutting the skin （t5）, and 1 min after splitting the sternum （t6）. Blood sample was taken from radial artery before going into the operating room （T0）, after the tracheal intubation （T1）, after splitting the sternum （T2）, before rewarming （T3）, 10 min after the stop of CPB （T4）, 24 h after the operation （T5） for the determination of concentration of serum cortisol （Cor）, and adrenocorticotropic hormone during operation. Results ① Heart rate in group S was significantly lower than that in group F at t2 and t3 （P（ 0. 05）. Mean arterial pressure in group S was significantly lower than that in group F at t3 （P（0. 05）. We got more stable blood pressure and heart rate in group S. ②Cortisol increased significantly at T2, T4, and T5 as compared with To （P〈0.05）. Cortisol was significantly lower at T4 and T5 in group S than that in group F （P〈0.05）. Adrenocor- ticotropic hormone increased significantly at T1-5 as compared with To （P〈0.05）. Adrenocorticotropic hormone was significantly lower at T2, T4, and T5 in group S than that in group F （P〈0. 05）. Conclusion Sufentanyl can be safely used in open heart surgery. We can get more stable hemodynamics, and fewer stress reactions in pediatric patients undergoing surgical repair of congenital cardiac defects.