等效剂量舒芬太尼和瑞芬太尼对老年患者全麻诱导应激反应的影响

Effect of Equivalent Dose Sufentanil and Remifentanil on Stress Response to Anesthesia Induction in the Elderly.

目的采用等效剂量的舒芬太尼和瑞芬太尼,在相同的麻醉深度下观察快速诱导气管内插管时的血流动力学和应激反应变化。方法老年全麻患者54例,随机分为3组,舒芬太尼组(SF组)诱导用舒芬太尼0.4μg/kg、瑞芬太尼组(RF组)用瑞芬太尼2μg/kg和芬太尼组(F组)用芬太尼3μg/kg。比较全麻诱导各时段的血流动力学和血浆儿茶酚胺浓度。结果与全麻诱导前相比,3组在插管前MAP降低(P<0.05),F组和RF组CI下降(P<0.05),SF组CI无明显变化。F组SVRI升高(P<0.05),SF组的变化无统计学差异,RF组明显下降(P<0.01)。插管后SF组和RF组SVRI升高(P<0.05)。F组气管插管后肾上腺素浓度升高(P<0.05),高于SF组和RF组(P<0.05)。结论舒芬太尼和瑞芬太尼对老年患者全麻诱导应激反应的抑制作用强于芬太尼,但是心血管稳定性方面舒芬太尼优于瑞芬太尼。

Objective To observe the effect of equivalent dose sufentanil and remifentanil on stress response to general anesthesia induction in the elderly patients under the same depth of anesthesia. Methods Fifty - six elderly patients were divided into three groups. Anesthesia was induced with sufentanil 0.4μg/kg in group SF, remifentanil 2μg/kg in group RF and fentanly 3μg/kg in group F. The hemodynamies and plasma catecholamines were measured during induction of general anesthesia. Results After sufentanil, remifentanil or fentanly injection, MAP decreased among three groups and HR decreased in group RF. CI remained no change in group SF. SVRI increased in group F （P 〈 0.05） , decreased significantly in group RF, while group SF had no significant difference. After tracheal intubation, SVRI increased significantly in group SF and RF （P 〈 0.05）. The concentration of adrenaline after tracheal intubation was significantly higher in group F than in groups SF and RF（P 〈 0.05）. Conclusion Compared with fentanyl, sufentanil and remifentanil have more inhibitory effect on stress response to induction of general anesthesia in the elderly patients. But sufentanil has more cardiovascular stability than remifentanil.