舒芬太尼麻醉用于心血管手术的多种临床研究

Sufentanil Anesthesia for Cardiovascular Surgery:a Randomized Multicentre Clinical Trial

目的:探讨舒芬太尼用于多类型心血管手术的临床效果。方法:选取包括本院在内10所医院的400例在低温、全身麻醉和心肺转流条件下施行冠状动脉搭桥术和/或心脏瓣膜置换术的患者,随机分为两组,舒芬太尼组300例,芬太尼组100例,舒芬太尼组给予舒芬太尼和咪唑安定进行手术麻醉,芬太尼组给予芬太尼和肌松药,记录两组麻醉诱导前后和手术后的各项指标及不良反应以分析临床效果。结果:两组麻醉过程顺利,无明显不良反应,在手术后恢复良好。舒芬太尼组和芬太尼组的所有病例麻醉诱导后的心率、平均动脉压均较诱导前明显降低(P<0.05),中心静脉压在诱导后较诱导前高(P<0.05),瓣膜组气管插管后,舒芬太尼组的中心静脉压明显高于芬太尼组(P<0.05或P<0.01),搭桥组在麻醉诱导后和气管插管后1、5、10min,舒芬太尼组的心率和平均动脉压均明显低于芬太尼组(P<0.05或P<0.01),气管插管后,舒芬太尼组的中心静脉压明显高于芬太尼组(P<0.05或P<0.01)。舒芬太尼组诱导总量和诱导浓度均明显低于芬太尼组。组间术后清醒时间和拔管时间比较差异无统计学意义(P>0.05)。结论:舒芬太尼和芬太尼分别麻醉用于心血管手术均有良好、安全的效果,但舒芬太尼对血流动力学因素的影响更小,是较为理想的麻醉方法。

Objective： To investigate curative effects of f sufentanil anesthesia used in multiple cardiovascular surgery.Method： 400 patients undergoing valvular surgery and/or coronary artery bypass grafting （ CABG ） under cardiopulmonary bypass （ CPB ） from 10 hospitals including our hospital in China were randomly divided into sufentanil group （ 300 cases ） and fentanyl group （ 100 cases ） two groups.Sufentanil group was applied sufentanil and midazolam for operative anesthesia; fentanyl group was applied fentanyl and muscle relaxant for operative anesthesia.The results and the marked side effects of two groups were recorded before anesthesia, after anesthesia, pre-operation and post-operation, then the clinical treatment effect was analyzed.Result： The anesthesia process of two groups was successful.All patients in both groups recovered well without any marked side effects.The heart rate and mean arterial pressure of all patients in both groups after anesthesia were lower than which were before anesthesia （ P〈0.05 ） .The central venous pressure of all patients in both groups after anesthesia were higher than which were before anesthesia （ P〈0.05 ） .After trachea cannula, the central venous pressure of all patients in sufentanil group were higher than fentanyl group undergoing valvular surgery （ P〈0.05 or P〈0.01 ） .After anesthesia, the first minute, the fifth minute and the tenth minute after trachea eannula, the heart rate and mean arterial pressure of all patients in sufentanil group were lower than fentanyl group undergoing coronary artery bypass grafting （ CABG ） （ P〈0.05 or P〈0.01 ） .After trachea eannula, the central venous pressure of all patients in sufentanil group were higher than fentanyl group undergoing coronary artery bypass grafting （ CABG ） （ P〈0.05 or P〈0.01 ） .The inductive total and the inductive effect in were sufentanil group were lower than fentanyl group.There were no significant differences in recovery and extubatian time between two groups （P〉0.05） .Conclusion： Both sufentanil and fentanyl can be used well and safely for cardiovascular surgery.But for the effect of hemodynamic factors, sufentanil is smaller than fentanyl.So sevoflurane anesthesia for cardiovascular surgery is ideal.