芬太尼复合麻醉对心脏手术时心血管的影响

Cardiovasculai Effects of Fentanyl Balanced Anesthesia in Caidiac Surgery

我们在20例先天性心脏病房室间隔缺损患者(Ⅰ组)和20例心瓣膜病患者(Ⅱ组)中分别应用了芬太尼(30μg/kg)+氯胺酮(3mg/kg)+箭毒(0.5mg/kg)+安氟醚(1.25％)和芬太尼(50μg/kg)+安定(0.2mg/kg)+箭毒(0.5mg/kg)+安氟醚(1.0％)两种复合麻醉,行体外循环心内直视手术。并观察了麻醉和手术对心血管的影响。除了Ⅱ组17例心率下降较大,需静注阿托品外,两组病人麻醉诱导平稳,血压改变轻微,气管内插管时无显著的血流动力学反应,而手术刺激时心功能较好者血压升高显著。

We have observed cardiovascular changes during anesthesia and surgery in 40 patients. Fetanyl 30μg/kg combined with ketamine 3mg/kg, d-tubocurarine 0.5mg/kg and 1.25% enflurane was used in 20 patients (group Ⅰ), with congenital heart diseases undergoing defect repairs. 20 patients (group Ⅱ), with valvular heart diseases underwent heart surgery under another fentanyl balanced anesthesia consisting of fentanyl 50μg/kg, diazepam 0.2mg/kg, d-tubocurarine 0.5mg/kg and 1% enflurane. The heart rate decreased significantly and atropine was given introvenously in 17 patients in group Ⅱ. Induction of anesthesia was smooth with only mild blood pressure changes in both groups. Hemodynamic responses to tracheal intubation were completely blocked. However, blood pressure increased significantly during surgery in patients with better ventricular function.