苏芬太尼用于老年患者全身麻醉诱导对心排血量和血流动力学的影响

Effects of sufentanil, remifentanil or fentanyl on cardiac output of elder patients during induction of general anesthesia

目的 观察等效剂量的苏芬太尼、瑞芬太尼、芬太尼用于老年患者全身麻醉诱导对心排血量和血流动力学的影响.方法 择期老年手术患者90例,按美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级,采用随机数字表法分为苏芬太尼组（S组）、瑞芬太尼组（R组）和芬太尼组（F组）,每组各30例.常规诱导,气管插管前采用盲法分别静脉注射苏芬太尼0.2 μg/kg、瑞芬太尼2μg/kg和芬太尼2μg/kg.分别测量并记录各组诱导前基础值（T0）,诱导后（T1）、插管后1 min（T2）、插管后3min（T3）收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）、心排血量（CO）、心指数（CI）和外周血管阻力（SVR）等心功能指标的变化,并记录不良反应：心动过缓、低血压等.结果 与基础值相比,各组诱导后MAP降低（P＜0.05）,R组CO下降（P＜0.05）,S组CO无明显变化.插管后R组MAP、CO有明显下降；F组MAP、HR有明显升高；S组患者的CO、MAP在诱导过程无明显波动（P＞0.05）.结论 苏芬太尼和瑞芬太尼用于老年患者麻醉诱导,抑制插管时应激反应的效果优于芬太尼,但是心血管稳定性方面苏芬太尼优于瑞芬太尼.

Objective To compare the effects of equivalent dose sufentanil,remifentanil or fentanyl on hemo- dynamic and cardiac output in the elderly patients during induction of general anesthesia. Methods Ninety elderly patients（ASA I -II ） undergoing elective abdominal surgery under general anesthesia were randomly divided into sufentanil group （group S） , remifentanil group （group R） and fentanyl group（ group F） ,30 patients in each group. Pa- tients in group S, group R and group F received sufentanil 0.2μg/kg, remifentanil 2μg/kg and fentanyl 2μ g/kg IV, respectively, using an blind method before intubation. SBP, DBP, MAP, HR, CO, CI and SVR were recorded before of anesthesia （ To ）, immediately after induction （ T1 ）, 1,3 minutes after tracheal intubation （ T2, T3 ）. Changes of SBP and HR during observation were also recorded. Results The MAP and HR in three groups at T1 were significantly lower than those at To and decreased significantly in group R than those in group F and S（P 〈0.05）. The MAP and HR in group F significantly increased at T1 than TO. The MAP and HR in group R were significantly decreased after tracheal intubation. Compared with the baseline, the MAP and HR in group S at T1, T2, remained unchanged. In group R, there were two patients whose HR were under 50 bpm. In group F, the MAP at T1, T2 were significantly higher than those at T. In group S, there were no significant changes in CO, CI, SVR which were all within normal range （ P 〉 0. 05 ）. Conclusion Both sufentanil and remifentanil effectively inhibit the stress response during induction of general anes- thesia. At the same time, sufentanil has better hemodynamic stability.