舒芬太尼和芬太尼用于体外循环下冠状动脉旁路移植术患者的效果分析

Effect analysis of Sufentanil and Fentanyl in on-pump coronary artery bypass graft

目的 研究比较舒芬太尼和芬太尼在体外循环（CPB）冠状动脉旁路移植术（on-pump CABG）中对血流动力学及血清心肌肌钙蛋白（cTn Ⅰ）浓度的影响.方法 选择2013年2～6月邢台市第三医院择期行冠状动脉旁路移植术患者60例,随机分成两组,每组30例.舒芬太尼组（S组）分别于麻醉诱导、切皮前、劈胸骨前、体外循环转流前、停机后各静注舒芬太尼1 μg/kg;芬太尼组（F组）分别于麻醉诱导、切皮前、劈胸骨前、体外循环转流前、停机后各静注芬太尼10 μg/kg.比较两组术中血流动力学参数及血清心肌cTn Ⅰ浓度.结果 血流动力学比较：气管插管即刻（T1）及切皮（T2）两组心率（HR）、平均动脉压（MAP）比麻醉诱导前（T0）升高（P＜0.05）,F组比S组升高明显（P＜0.05）,停机后即刻（T4）HR[（68.5±12.2）、（66.8±]1.2）次/min]和停机后30 min（T5）HR[（72.5±8.5）、（67.8±9.6）次/min]高于T0（56.6±7.2）、（554±8.0）次/min] （P＜0.05）,两组间其他差异无统计学意义（P＞0.05）.心肌cTn Ⅰ浓度比较：术前S组[（0.67±0.22）μg/L]与F组[（0.71±0.20）μg/L]比较差异无统计学意义（P＞0.05）,所有血管桥开放后4、8、24、48 h,两组均高于术前（P＜0.05）,S组[（2.37±0.55）、（1.82±0.62）、（1.42±0.33）、（0.84 ±0.28） μg/L]低于F组[（3.08±1.12）、（3.62±0.98）、（1.89±0.57）、（1.32±0.47）μg/L]（P＜0.05）.结论 体外循环冠状动脉旁路移植术使用舒芬太尼麻醉,血流动力学更平稳,术后血清心肌cTn Ⅰ较低,心肌保护作用较好.

Objective To compare the effect of Sufentanil and Fentanyl on hemodynamics and the concentration of serum cardiac troponin Ⅰ （cTn Ⅰ） in on-pump coronary artery bypass graft （on-pump CABG）.Methods 60 cases of patients who received coronary artery bypass graft surgery at a selecting time,were randomly divided into two groups,30 cases were in each group.Patients in Sufentanil group （group S） and in Fentanyl group （group F） were administrated by intravenous injection of Sufentanil （1 μg/kg） and Fentanyl （10μg/kg） respectively before anesthesia induction,cuting skin,splitting breastbone,extracorporeal circulation flow,and after downtime.At last the parameters of hemodynamics and the concentration of serum cTnⅠ were compared between the two groups.Results In respect of hemodynamic,the levels of heart rate （HR） and mean arterial pressure （MAP） at the point of endotracheal intubation （T1） and cuting skin immediately （T2） rose obviously which were more than those before anesthesia induction （T0） （P ＜ 0.05）.The levels of the HR and MAP significantly increased in group F than those in group S.The HR at downtime immediately （T4） [（68.5±12.2）,（66.8±11.2） times/min] and after 30 min downtime （T5） [（72.5±8.5）,（67.8±9.6） times/min] were higher than those of T0 [（56.6±7.2）,（55.4±8.0） times/min] （P ＜ 0.05）.But the other parameters of hemodynamics had no significant difference between group F and group S （P ＞ 0.05）.In the aspect of the concentration of serum cTnⅠ,there was no statistical difference between the two groups [（0.67±0.22） μg/L and （0.71±0.20） μg/L] before operation （P ＞ 0.05）.But the levels of the cTnⅠ of both the group at the point of 4,8,24,48 hours after all the vessels bridge opening,were obviously higher pre-operation than post-operation （P ＜ 0.05）,and the levels in group F [（3.08±1.12）,（3.62±0.98）,（1.89±0.57）,（1.32±0.47） μg/L] were higher than that in group S [（2.37±0.55）,（1.82±0.62）,（1.42±0.33）,（0.84±0.28） μg/L] （P ＜ 0.05）.Conclusion Compared with Fentanyl,the application of Sufentanil during on-pump CABG can make the hemodynamics steadier,the level of cTn Ⅰ lower,and can attenuate ischemia-reperfusion injury of myocardium,so it has better cardioprotective effects.