舒芬太尼和芬太尼对冠状动脉旁路移植术患者脑损伤影响的比较

Effects of sufentanil vs.fentanyl on cerebral injury in patients undergoing coronary artery bypass graft

目的比较冠状动脉旁路移植术中舒芬太尼和芬太尼麻醉对患者脑损伤的影响。方法择期冠状动脉旁路移植术患者30例,随机分为舒芬太尼组和芬太尼组,每组15例。舒芬太尼组诱导采用舒芬太尼1.0～1.5μg·kg^(-1),术中舒芬太尼1.0～2.0μg·kg^(-1)·h^(-1)维持静脉泵注;芬太尼组诱导采用芬太尼10～15μg·kg^(-1),术中芬太尼10～20μg·kg^(-1)·h^(-1)维持静脉泵注。分别于切皮前(T_0),体外循环30 min(T_1),体外循环结束(T_2),术后4 h(T_3)、12 h(T_4)、24 h(T_5)采颈静脉血测定S-100β蛋白和神经元特异烯醇化酶(NSE)浓度。于麻醉诱导前、术后1 d和术后3 d记录简易智能量表(MMSE)评分。结果 2组S-100β蛋白和NSE浓度在T_1～T_4时均高于T_0(P<0.05),舒芬太尼组T_1～T_3时S-100β蛋白低于芬太尼组(P<0.05),T_1～T_4时NSE低于芬太尼组(P<0.05)。2组MMSE评分在术后1 d均较麻醉诱导前降低,舒芬太尼组评分高于芬太尼组(P<0.05)。2组均无严重不良反应发生。结论与芬太尼相比,在同等效应剂量下舒芬太尼可减少S-100β蛋白和NSE的释放,升高患者MMSE评分,对于冠状动脉旁路移植术患者有更好的脑保护作用。

AIM To compare the effects of sufentanil and fentanyl on cerebral injury in undergoing coronary artery bypass graft during cardiopulmonary bypass （CPB）. METHODS Thirty patients patients scheduled for coronary artery bypass graft （ASA Ⅱ- Ⅲ, n = 30） were randomly divided into 2 groups （15 for each）. Anesthesia was induced with sufentanil （1.0 - 1.5 μg·kg^-1 and maintained with 1.0 - 2.0 μg·kg^-1·h^-1） or fentanyl （10 - 15 μg·kg^-1 and maintained with 10 - 20 μg·kg^-1·h^-1） , the other drugs were same in both groups. Blood samples were taken from jugular vein for the determination of plasma S-100 β protein and neurone specific enolase （NSE） concentration before skin incision （T0）, at 30 min after CPB （T1）, the end of CPB （T2）, 4 h （T3）, 12 h （T4） and 24 h （T5） after the operation. The mean mini-mental state examination （MMSE） scores were calculated before anesthesia, 1 d and 3 d after the operation. RESULTS The plasma concentration of S-100βprotein and NSE were significantly increased after CPB in both groups as compared with To （P 〈 0.05） . The levels of S-100 β protein at T1-T3, NSE at T1-T4 were lower in the sufentanil group than those in the fentanyl group （P 〈 0.05） . The MMSE scores at 1 d after operation were higher in the sufentanil group as compared with the fentanyl group. There were no serious adverse reactions observed in both groups. CONCLUSION Compared with fentanyl, sufentanil can decrease the releasing of S-100 β protein and NSE, and appears to provide better brain protection to patients undergoing coronary artery bypass graft during CPB.