舒芬太尼用于老年胸科病人全身麻醉诱导的血液动力学变化

Hemodynamic changes of sufentanil during induction of general anesthesia in the elder patients of chest surgery

目的比较舒芬太尼和芬太尼用于老年胸科病人全身麻醉诱导时血液动力学变化,探讨更佳的麻醉诱导方案。方法 36例择期肺癌根治术病人,年龄65～76岁;男19例,女17例,ASAⅠ～Ⅲ级。按随机数字表法分为舒芬太尼组(S)和对照组(F),每组18例。全麻诱导依次使用依托咪酯0.2 mg/kg,舒芬太尼0.4μg/kg(S组)或芬太尼3μg/kg(F组),维库溴铵0.1 mg/kg,舒芬太尼和芬太尼由专人配制,且与麻醉实施者非同一人。连接无创血液动力学监测仪,分别于全麻诱导前(T0)、诱导后插管前(T1)、气管插管后1 min(T2)、2 min(T3)、10 min(T4)监测心率(HR)、中心静脉压(CVP)、平均动脉压(MAP)、心排血量(CO)、每搏量(SV)、左心做功指数(LCWI)、左心室射血时间(LVET)、外周血管阻力(SVR)。结果 (1)LCWI及CVP两组间及各组内均无明显变化(P均>0.05);(2)HR:2组诱导(T1)后均有不同程度变化(P均<0.05),但插管后(T2～T4)S组即恢复至正常,且T2、T3低于F组(P均<0.05);(3)MAP:2组诱导(T1)后均有下降(P均<0.05),组间T1～T4差异有统计学意义(P均<0.05);(4)CO:2组诱导(T1)及插管后(T2、T3)均有变化(P均<0.05),但S组T1～T4高于F组(P均<0.05);(5)SV:2组插管(T2、T3)后均下降(P均<0.05),且S组T1～T4高于F组(P均<0.05);(6)SVR:2组诱导(T1)后均明显下降(P均<0.01),插管后T1～T4有所回升,但仍低于诱导前(P<0.05或P<0.01),组间无明显差异。结论舒芬太尼对血流动力学影响较小,更适合老年胸科病人全身麻醉诱导。

Objective To compare the hemodynamic changes between sufentanil and fentanyl during induction of general anesthesia in elder patients of thoracic operation for seeking a better drug of anesthesia induction. Methods Thirty-six patients with lung cancer intending to receive radical surgery （ 19 males, aged 65 - 76 years, ASA 1 - In grads） were randomly divided into sufentanil（ S group） and fentanyl （ F group） groups （n = 18 each）. During induction of general anesthesia,etomidate 0.2 mg/kg, sufentanil 0.4 μg/kg （ S group） or fentanyl 3μg/kg（ F group）, Midazolam 0.04 mg/kg and vecurenium O. 1 mg/kg were administered in turn. Heart rate （HR）, central venous pressure （CVP）, mean arterial pressure （MAP）, cardiac output （ CO）, stroke volume （SV）, left ventricular work index （ LCWI）, left ventricular ejection time （LVET） and peripheral vascular resistance （SVR）were monitored with non-invasive hemodynamic monitor at before induction of anesthesia （T0）, after induction before intubation （T1） ,at 1 minute （T2） ,2 minute （T3）,and 10 minute （T4） after intubation, respectively. Results There were no significant changes in LCWI and CVP between two groups （all P 〉 0. 05 ）. Compared with TO, there were changes of different degrees after T1 in both groups on HR（all P 〈0. 05） ,which recovered normal at T2 -T4 and lowered at T2 and T3 in S group than that in group F （ all P 〈 0. 05 ）. All MAP after T1 decreased in two groups （ all P 〈 0. 05 ）, which had statistical difference（all P 〈0. 05）at T1 -T4 between two groups. There were changes at T1 ,T2 and 33 in two groups on CO（all P〈0.05） ,which was higher at T1 -T4 in S group than that in F group （all P 〈0.05）. All SV at T2 and 13 decreased in two groups（ all P 〈 0. 05 ） and were higher at T1 - T4 in S group than those in F group （ all P 〈 0. 05 ）. All SVR after T1 in two groups obviously decreased （all P 〈 O. O1 ） and had a ascending trend at T2 - T4 after intubation, but were still lower than those at TO （ P 〈 0.05 or P 〈 0. 01 ）. There was no significant difference on SVR in two groups. Conclusions The hemodynamics of sufentanil for induction of general anesthesia are more stable in older patients of thoracic operation, and it is supe- rior to fentanyl.