舒芬太尼和芬太尼用于小儿先心病手术的麻醉比较

Comparison of anesthetic effect of sufentanil and fentanyl in pediatric undergoing surgical repair of congenital heart disease

目的:观察比较舒芬太尼和芬太尼用于小儿先心病手术的麻醉效应及术后恢复情况。方法:40例先心矫正手术患儿随机分成舒芬太尼组(SF组)和芬太尼组(F组),每组20例。复合咪唑安定、丙泊酚、罗库溴铵和七氟烷实施全程静脉麻醉,分别在诱导时、切皮前、锯胸骨前各时点静脉注射舒芬太尼(SF组)1μg.kg-1和芬太尼(F组)10μg.kg-1,观察并记录患儿入室时(基础值,T0)、诱导时(T1)、插管时(T2)、切皮时(T3)、锯胸骨时(T4)、关胸时(T5)的心率(HR)和平均动脉压(ABP),以及阿片药物用量和术后清醒、拔管时间。结果:两组患儿术前一般情况、心肺转流(CPB)时间、手术时间差异无显著意义(P>0.05)。T1时点F组HR、MAP下降明显,与T0比较差异有显著意义(P<0.05)。SF组HR、MAP下降与T0比较差异无显著意义(P>0.05)。T3、T4时,F组HR升高(P<0.05),MAP基本稳定。SF组清醒时间和拔管时间均明显短于F组(P<0.05)。结论:舒芬太尼用于小儿先心病手术麻醉安全有效,与等效剂量芬太尼相比具有心率和血压变化更为稳定的优点。

Objective： To compare the analgetic use of sufentanil and fentanyl in pediatric undergoing cardiac surgery with cardiopulmonary bypass and postoperative effects of anesthesia recovery. Methods： 40 pediatric patients undergoing elective surgery repair of congenital heart disease were randomly divided into sufentanil group （ SF group） and fentanyl group （ F group）, 20 cases of each group. The patients were anesthetized with sufentanil or fentanil combined with midazolam-propofol-rocuroniumsevoflurane. Respectively, sufentanil （SF group） 1 μg·kg^-1 or fentanyl （F group） 10 μg·kg^-1 were injected before induction, skin incision and sternal saw. Mean arterial pressure （MAP） and heart rate （HR） were observed during anesthesia （To： baseline; T1： 2 min offer anesthesia induction; T2： immediately after tracheal intubation ; T3 ： skin incision ; T4 ： sternal saw ; T5 ： closing thoracic cavity）. The dose of sufentanil and fentanil, the time of awakening from anesthesia, and the extubation time were recorded. Results： The results of two groups with preoperative general circumstances, cardiopulmonary bypass （CPB） time and operation time showed no significant difference （P 〉 0.05 ）. Comparing with To, The HR and MAP decreased significantly （ P 〈 0.05 ） at T, but HR increased significantly （P 〉 0.05） at T3, T4 in F group, whereas there was no significant difference in SF group （P 〈 0.05 ）. SF group＇s sober and extubation time were significantly shorter than that of F group＇s （P 〈 0.05）. Conclusions： Sufentanil anesthesia was safe and effective for patient undergoing surgery repair of congenital cardiac defects with cardiopulmonary stability.