芬太尼、舒芬太尼和瑞芬太尼在老年患者全麻诱导时引起心动过缓的比较研究

Comparison of fentanyl,sufentanil and remifentanil inducing beckoning bradycardia in elderly patients during general anesthesia induction

目的分析等效剂量的芬太尼、舒芬太尼和瑞芬太尼在老年患者全身麻醉时引起心动过缓的不良反应,为临床治疗提供参考。方法选择符合美国麻醉医师协会（ASA）分级标准Ⅰ-Ⅱ级择期全身麻醉下拟行上腹部手术的老年患者93例,随机分为芬太尼组（Ⅰ组）、舒芬太尼组（Ⅱ组）和瑞芬太尼组（Ⅲ组）,观察记录三组患者于麻醉诱导前（T0）、诱导后插管前（T1）、和插管后3分钟（T2）3个时间点的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）以及心率（HR）的变化。记录三组患者心动过缓的发生率。结果Ⅰ组患者的SBP、DBP、MAP、HR在T2时间点时较T1时间点显著升高,差异具有显著性（P〈0.05）;Ⅲ组患者的SBP、DBP、MAP、HR在T1-T2时间段较T0时间点显著降低,差异具有显著性（P〈0.05）。在T1时间点,Ⅰ组和Ⅲ组患者的SBP、DBP、MAP、HR与Ⅱ组患者比较明显降低,差异具有显著性（P〈0.05）;在T2时间点,Ⅲ组患者的SBP、DBP、MAP、HR明显低于Ⅰ组和Ⅱ组,差异具有显著性（P〈0.05）。Ⅲ组8例（25.80%）,患者发生心动过缓,明显高于Ⅰ、Ⅱ组[2例（6.45%）,1例（3.23%）],差异具有显著性（P〈0.05）。结论芬太尼对麻醉诱导期的应激反应抑制作用不佳,瑞芬太尼能够引发严重的心动过缓,舒芬太尼不仅能够有效维持老年患者麻醉诱导时血流动力学的稳定性,而且无明显的心血管抑制作用,其用于老年患者全身麻醉诱导时更安全。

Objective Analysis of equivalent doses of fentanyl, sufentanil and remifentanil cause adverse reactions bradycardia during general anesthesia in elderly patients, to provide reference for clinical practice. Method Selected the American Society of Anesthesiologists（ASA） Ⅰ-Ⅱ elective body of elderly patients undergoing abdominal surgery on 93 patients under anesthesia were randomly divided into fentanyl（group Ⅰ）, sufentanil group（group Ⅱ） and rui fentanyl group（group Ⅲ）, observed and recorded three groups of patients before induction of anesthesia（T0）, systolic blood pressure before intubation（T1）, and 3 minutes after intubation（T2） 3 time points after induction（SBP） diastolic blood pressure（DBP）, mean arterial pressure（MAP） and heart rate（HR） changes. Recorded three groups of patients incidence of bradycardia. Result SBP, DBP, MAP, HR of group Ⅰ at the T1 time point was significantly increased than T2 time point, the difference was significant（P〈0.05）; group Ⅲ patients with SBP, DBP, MAP, HR at T1 - T2 time segment were significantly lower than T0 time point, the difference was significant（P〈0.05）. At the T1 time point, SBP, DBP, MAP, HR of group Ⅰ and group Ⅲ were significantly lower group Ⅱ, the difference was significant（P〈0.05）; at the T2 time point, SBP, DBP, MAP, HR of group Ⅲ was significantly lower than group Ⅰ and group Ⅱ, the difference was significant（P〈0.05）. Three was 8 cases（25.80%） occured bradycardial in group Ⅲ, obviously higher than that of group Ⅰ and Ⅱ [2 cases（6.45%）, 1 cases（3.23%）], the difference was significant（P〈0.05）. Conclusion The inhibitory effect of fentanyl in response to the stress induction of anesthesia with remifentanil is poor, can cause serious heartbeat bradycardia, sufentanil can effectively maintain the stability of hemodynamics in elderly patients during induction, and no obvious inhibitory effect on cardiovascular, suggesting that the induction of general anesthesia for the elderly is more safe.