舒芬太尼对高血压患者诱导插管的影响

The observation of sufentanil was used for intubation of hypertension patients

目的评价舒芬太尼在高血压病患者全麻诱导插管中对血流动力学的影响。方法选择期估计手术时间>3h患有原发性高血压患者40例,年龄35～75岁,ASA II～Ⅲ级,随机分为舒芬太尼组(S组)和芬太尼组(F组),每组各20例。S组:用依托咪酯0.3mg/kg,舒芬太尼0.8ug/kg,顺式阿曲库铵0.2mg/kg麻醉诱导插管;F组:用依托咪酯0.3mg/kg,芬太尼8μg/kg,顺式阿曲库铵0.2mg/kg行麻醉诱导插管。观察记录麻醉诱导前、插管前即刻、插管后即刻、插管后5min患者的ECG、SpO2、有创动脉血压(MAP)、心率(HR)、脑电双频谱指数(BIS)等参数的变化,并记录术中出现的不良反应。结果与麻醉诱导前比较,S和F两组病人在插管前即刻、插管后5min的有创血压MAP、HR均降低,差异有统计学意义(P<0.05);插管后即刻差异无统计学意义(P>0.05);两组患者的BIS值均极明显降低,差异有统计学意义(P<0.01)。结论舒芬太尼用于较长时间手术的高血压病人的麻醉诱导比芬太尼对血流动力学的影响更小,更安全。

Objective The changes of hemodynamics was evaluated for anesthesia induction of sufentanil in hypertensive patients. Methods 40 cases of patients with essential hypertension, estimated operation time of more than three hours, aged 35 to 75 years old,ASA Ⅱ to Ⅲ grade, were randomly divided into the sufentanil group （S） and fentanyl group （F group） ,20 patients in each group. S Group： 0. 3mg/kg, sufentanil 0. 8ug/kg, cis-atracurium 0. 2mg/kg anesthesia induction and intubation with eto- midate; groups F：etomidate 0. 3mg/kg, fentanyl 8 μg,/kg, cis-atracurium 0. 2mg./kg lines anesthesia induction and intubation. The ECG, SpO 2,invasive arterial blood pressure （MAP） , heart rate （HR） , bispectral index （BIS） of the patient were observed and re- corded before induction of anesthesia, before intubation, immediately after the intubation, and intubation after five minutes. Re- sults Compared with before induction of anesthesia, two groups of patients of MAP and HR were obviously decreased at time-point of before intubation immediately and 5 minutes after intubation （P 〈 0. 05 ）. However, the time-point of ＇after intubation was not obviously difference （ P 〉 0. 05 ） ; BIS values of the two groups of patients were extremely lower than before-induction of anesthesia, the difference was highly significant （P 〈 0. 01 ）. Conclusion Safety of sufentanil is used for induction of anesthesia in the long-time surgery and hypertensive patients. Sufentanil has a smaller impact on the cardiovascular system than fentanyl, and the patient is more stable and comfortable.