短小手术中应用芬太尼和舒芬太尼喉罩全麻对患者血流动力学的影响

Influence of Sulfentanyl Combined Propofol or Fentanyl Combined Propofol Inserting LMA on Patients' Hemodynamics in Minor Surgery

目的比较短小手术中舒芬太尼复合异丙酚和芬太尼复合异丙酚诱导喉罩全麻对患者血流动力学的影响。方法将60例行短小手术的病人随机分为舒芬太尼-异丙酚全凭静脉麻醉组(S组)和芬太尼-异丙酚组(F组),所有病人术前30min肌注阿托品0.5mg,咪唑安定0.05～0.1mg/kg,入室后开放静脉,诱导前面罩吸氧,静注舒芬太尼0.7μg/kg(S组)或芬太尼5μg/kg(F组),异丙酚2mg·kg^(-1)诱导,插入LMA,微量泵持续静脉注入舒芬太尼0.5μg/(kg·h)(S组)或芬太尼4μg/(kg·h)(F组),复合持续泵入异丙酚,手术结束前30min停止注入舒芬太尼或芬太尼。分别于麻醉诱导前(T_0),喉罩置入前即刻(T_1),喉罩置入后1min(T_2),微量泵注药15min时(T_3),手术切皮时(T_4),手术结束时(T_5),手术结束后30min(_6)记录病人SBP、DBP、HR、心率×收缩压乘积(RPP),并抽取动脉血3ml注入试管,采用高效液相色谱法测定血浆中去甲肾上腺素(NE)和肾上腺素(E)水平。结果 S组的SBP,DBP,RPP在T_1时较T_0时明显下降(P<0.05),HR显著下降(P<0.05),F组T_1较T_0时明显下降(P<0.05),而组间比较无显著性(P<0.05)。T_2与T_0比较,F组的SBP,DBP,HR,RPP上升明显(P<0.05),而S组则无显著性差异(P<0.05),RPP T_2～T_6组间比较F组明显升高(P<0.05)。血浆中NE和E的变化:F组在T_2,T_6时较T_0时明显升高(P<0.05);S组各测定时点无显著性差异(P>0.05)。结论0.7μg/kg舒芬太尼复合异丙酚诱导喉罩全麻,对围术期的血液动力学影响较小。

Objective To explore the influence of sulfentanyl combined propofol or fentanyl combined propofol inserting LMA on patients＇hemodynamics in minor surgery. Methods Sixty ASA Ⅰ - Ⅱ patients were randomly divided into 2 groups：Sulfentanyl combined propofol total intravenous anesthesia group（group S） and fentanyl combined propofol group （ group F）. All patients were given intramuscular atropine 0.5 mg and midazolam 0.05 - 0.1 mg/kg before operation. After entering into the operation room, the vein channel was established, and aspired oxygen with face mask was used before inducement. Sulfentanyl（0.7 μg/kg, group S） or fentanyl （ 5 μg/kg, group F） combined propofol（ 2mg/ kg）was injected. After inserting the LMA, pumping sulfentanyl 0.5μg/（ kgoh） （group S） or fentanyl 4μ g/（kgoh） （group F） combined propofol was injected with micropump. 30mins before the end of the operation,stoping infusing sulfentanyl or fentanyl. Before the anaesthesia inducement （T0）, before LMA inserting（T1 ）, 1 min after LMA inserting （ T2 ）, 15min after micro-pump infusing medicine （ T3 ）, the on setting operating （ T4 ） , the operation ending （ T5 ）, and post-operation 30min （ T6 ）, patients＇ SBP, DBP, HR, the heart rate systolic pressure product （RPP） was recorded, and the plasma level of adrenalin （ NE ） and adrenalin （ E ） was measured by liquid chromatography. Results SBP, DBP and RPP in group S at T1 were decreased than those at T0 （ P 〈 0.05 ）. HR remarkably decreased （ P 〈 0.05 ）. In group F, compared with To, the SBP, DBP and RPP of T1 notably decreased （ P 〈 0. 05 ）, but among the F groups , those had no significent difference （ P 〈 0.05 ）. Compared with To, the SP, DP, HR, RPP of T2 in group F increased remarkably （ P 〈 0. 05 ）, but T2 of the group S had no significent difference compared with To （ P 〉 0.05 ）. The RPP at T2 - T6 increased remarkably compared with group F （ P 〈 0.05 ）. The adrenalin （ NE ） and adrenalin （ E ） in blood plasma ： Compare to To in group F, the change of NE and E in group F at T2, T6 compare to T0 obviously rised （ P 〈 0. 05 ） ; The group S at each determination point have no signifcant difference （ P 〉 0.05 ）. Conclusion Inducing with 0.7μg/kg sulfentanyl combined propofol, could have little influence on perioperative haemodynamics.