舒芬太尼和芬太尼对重症患儿心脏手术血流动力学影响的对比研究

Effects of fentanyl and sufentanil on hemodynamics in infants with severe congenital heart diseases undergoing cardiac surgery

目的比较舒芬太尼和芬太尼对重症患儿心脏手术血流动力学的影响。方法选择34例重症心脏病婴幼儿,男17例,女17例,年龄5～35个月,体重5～15kg。随机均分为F、S两组。两组均用咪唑安定和哌库溴铵诱导麻醉,F组诱导用芬太尼10μg/kg,继之泵入芬太尼20～30μg.kg-1.h-1;S组用舒芬太尼1μg/kg,继之泵入舒芬太尼2～3μg.kg-1.h-1维持麻醉,两组均间断应用咪唑安定和哌库溴铵。应用肺动脉漂浮导管技术测定心肺转流结束后15min(T1)、手术结束(T2)和手术后24h(T3)的心脏指数(CI)、体循环阻力指数(SVRI)和肺循环阻力指数(PVRI)。结果F组CI在T2、T3时明显低于T1时(P<0.05或P<0.01),且显著低于S组(P<0.05);两组SVRI均逐渐升高,T3时明显高于T1时(P<0.05);F组SVRI、PVRI在T2、T3时均高于S组(P<0.05)。结论在重症先天性心脏病婴幼儿心脏手术中,舒芬太尼复合麻醉稳定血流动力学优于芬太尼复合麻醉。

Objective To compare the effects of fentanyl and sufentanil on hemodynamics in infants with severe congenital heart diseases undergoing cardiac surgery. Methods Thirty four infants with severe congenital heart diseases, aged 5 to 35 months, were divided into two groups with 17 cases each. All infants were received anesthetic induction with midazolam and pipecuroniurn. The patients in group S were given sufentanil 1 μg/kg, which was followed by 2-3 μg·kg^-1·h^-1. The patients in group F were given fentanyl 10μg/kg,which was followed by 20-30μg·kg^-1·h^-1. With the Swan- Ganz catheter, cardiac index （CI）, systemic vascular resistance indexes （SVRI） and pulmonary vascular resistance indexes（PVRI） were measured at the time points of 15 min after cardiopulmonary bypass （T1）, at the end of operation （T2） and 24 h after operation （T3）. Results The CI in group F was lower at T2 and T3 than that at T1 （P〈0.05 and P〈0. 01） ,and than that in group S（P〈0.05）. The SVRI was significantly higher at T3 than that at T1 in two groups（P〈0. 05）. The SVRI and PVRI at T2 and T3 were significantly higher in group F than those in group S（P〈0. 05）. Conclusion Compared with fentanyl, sufentanil is better in stabilizing the hemodynamics in the infants undergoing heart surgery for severe congenital heart diseases.