舒芬太尼复合丙泊酚在非体外循环冠状动脉旁路移植术中的应用

Application and observation of sufentanil combined with propofol for general anesthesia in patients undergoing off - pump coronary artery bypass surgery

目的比较舒芬太尼和芬太尼复合丙泊酚对非体外循环冠状动脉旁路移植术（OPCAB）血流动力学稳定性及术后麻醉恢复情况。方法将24例择期全身麻醉下行冠状动脉旁路移植术（CABG）的患者随机平分为舒芬太尼组（S组）和芬太尼组（F组），麻醉诱导用咪唑安定0．05mg／kg、依托咪脂0．3mg／kg、维库溴铵0．15mg／kg，S组用舒芬太尼1μg/k，F组用芬太尼7μg/k，麻醉维持用丙泊酚2-4mg／（kg·h）持续泵入，维库溴铵0．1mg／（kg·b）持续泵入，s纽维持用舒芬太尼泵入0．5～1．5¨∥（kg·h），F组维持用芬太尼泵入5～10μg（kg·h）。比较两组在诱导前（T0）、插管后2min（T1）、锯胸骨后2min（T2）、搭桥后（L）、关胸时（T4）的心率（HR）、平均动脉压（MAP）、动脉血乳酸（Lac）、术后麻醉恢复以及心肌肌酸磷酸激酶同工酶（CK-MB）变化的情况。结果与F组相比，S组HR在T1、T2时显著小于F组（P〈0．05）；S组MAP在T1、T2、L和T4时显著低于F组（P〈0．05）；F组Lac在T3和T4时显著高于s组（P〈0．05）。S组丙泊酚和尼卡地平的用量明显少于F组（P〈0．05）。S组在术后24h和48h CK-MB显著低于F组（P〈0．05）。S组术后苏醒时间、气管导管拔出时间及ICU停留时间明显短于F组（P〈0．05）。结论两组患者麻醉效果满意，但舒芬太尼血流动力学表现稳定，麻醉恢复时间更短，用于冠状动脉旁路移植术麻醉更具优势。

Objective To compare the hemodynamic stablility and post - operative recovery with sufentanil or fentanyl for total intravenous anesthesia in patients undergoing off- pump coronary artery bypass surgery （OPCAB）. Methods 24 ASA Ⅱ - Ⅲ patients sched-uled for OPCAB were randomly divided into two groups to receive sufentanil -based general anesthesia （group S, n = 12） or fentanyl - based general anesthesia （group F, n = 12）. The patients were induced with 0. 05 mg/kg midazolam ,0.15 mg/kg vecuronium ,0.3 mg/kg etomidate, 1 μg/kg sufentanil （ group S） or 7 μg/kg fentanyl（ group F）. Anesthesia was maintained with 2 - 4 mg/（ kg·h） propofol,0.1 mg/（ kg ~ h） vecuronium,0.5 - 1.5 μg/（ kg · h） sufentanil （ group S ） or 5 - 40μg/ （kg · h） fentanyl（group F）. MAP（ mean arterial pressure） , HR （heart rate） were recorded and blood samples were taken for the measurements of concentration of artery blood lactate （Lac）before induce（ TO ） ,2 min after intubation （T1 ） ,2 rain after sternotomy（ T2 ） ,post -bypass grafting （T3 ） and sternal wire placement （T4）. Operation time ,extubation time and awake time were recorded. The myocardium creatine kinase isozyme MB （ CK - MB） perioperatively were examined. Resuits Compared with group F, HR was less at T1, T2 （ P 〈 0. 05 ） and MAP was lower in group S at T1, T2 , T3 , T4 （ P 〈 0. 05 ）. Lac was lower in group S than group F. Total doses of propofol and the patients who given nicardipine and esmolol were more in group F. CK - MB was lower in group S at postoperative. There was significant difference in awake time, extubation time and ICU time between the two groups, they were much shorter in group S （ P 〈0.05 ）. Conclusions Sufentanil can maintain satisfied hemodynamics and shorten anesthesia recovery time,it has some advantage in OPCAB surgery.