芬太尼与舒芬太尼对气管插管时血浆ET和TXA_2的影响

EFFECT OF FENTANYL AND SUFENTANIL ON ET AND TXA_2 IN THE PROCESS OF TRACHEAL INTUBATION

目的:探讨芬太尼与舒芬太尼在气管插管过程中对血浆内皮素(ET)、血栓素A2(TXA2)的影响及其意义。方法:将符合实验条件的60名择期全麻手术病人随机分为两组:芬太尼组(F组)和舒芬太尼组(S组),各30例。全麻诱导:F组静注咪唑安定0.05 mg/kg,芬太尼3.0μg/kg,异丙酚1.5 mg/kg,阿曲库铵0.15 mg/kg;S组将芬太尼替换为舒芬太尼0.4μg/kg,其余同F组。分别记录麻醉诱导前2 min(T1)、气管插管前即刻(T2)、插管后1 min(T3)、3 min(T4)、6 min(T5)和10 min(T6)病人的收缩压(SBP)、舒张压(DBP)和心率(HR),同时抽取静脉血,测定血浆ET和TXA2含量。结果:F组气管插管后各时点ET和TXA2含量明显高于基础值(P<0.05);S组气管插管后ET含量与基础值比较无显著变化(P>0.05),TXA2含量较基础值升高,但上升幅度明显小于F组,两组在气管插管后的四个时点ET、TXA2含量组间比较具有显著性差异(P<0.05)。结论:气管插管可引起机体血浆ET和TXA2含量的增加,与芬太尼相比,舒芬太尼能够更加有效地抑制ET、TXA2的合成与释放,对手术病人具有更好的保护作用。

Objective： To observe the effect of fentanyl and sufentanil on plasma endothelin（ ET） 、thromboxane A2（ TXA2） in the process of trachea intubation and provide reference for reasonable patients selection of narcotic analgesic. Methods： 60 undergoing selective operation and according with our experiment qualification were divided into two groups,fentanyl group（ group F,n = 30） and sufentanil group（ group S,n = 30）,30 cases in each group. General anesthesia induction： In group F,intravenous injected midazolam 0. 05 mg / kg,fentanyl 3. 0μg / kg,prop ofol 1. 5 mg / kg,atracurium0. 15 mg / kg·In group S,intravenous injected midazolam 0. 05 mg / kg,sufentanil 0. 4μg / kg,propofol1. 5 mg / kg,atracurium 0. 15 mg / kg·Six points of time were set up： 2 minutes before induction（ T1）,before trachea intubation（ T2）,1 minute（ T3） 、3 minutes（ T4） 、6 minutes（ T5） 、10 minutes（ T6） after trachea intubation. At these six points of time,we monitored and recorded systolic blood pressure（ SBP）,diastolic blood pressure（ DBP）,heart rate（ HR） and drew venous blood to detect the contents of ET and TXA2 by radio-immunity method. Results： In group F,the content of ET and TXA2 at every point of time after trachea intubation were higher significantly than 2 minutes before induction（ P0. 05）,In group S,ET did not change obviously and TXA2 increased after trachea intubation. Between the two groups,the contents of ET and TXA2 at four points of time after trachea intubation were different significantly（ P0. 05）. Conclusions： the contents of ET and TXA2 increase obviously in the process of trachea intubation,sufentanil can significantly restrain the production of ET、TXA2in the process of trachea intubation and. protect the patients better.