舒芬太尼复合异丙酚在急性心肌梗死镇痛中的应用研究

The use of sufentanil combined with propofol for analgesia in patients with acute myocardial infarction

目的探讨舒芬太尼复合异丙酚麻醉在急性心肌梗死镇痛中的应用效果。方法按随机数字表法将118例急性心肌梗死镇痛患者分为舒芬太尼组与瑞芬太尼组,每组59例。舒芬太尼、瑞芬太尼初始靶效应室浓度分别为0.25、2ng/ml,均复合初始血浆靶浓度为2μg/ml的异丙酚,每2min增加0.5μg/ml,直至患者意识消失。比较两组患者在麻醉诱导前(T0)、插管前(T1)、插管后即刻(T2)、插管后2min(T3)、术毕(T4)和拔管(T5)时的血流动力学变化以及两组麻醉情况、苏醒时间、术后镇痛效果、并发症发生情况。结果两组收缩压(SBP)和舒张压(DBP)于T0–T2时逐渐下降,T2–T5时逐渐上升,心率(HR)于T0–T1时逐渐下降,T1–T5时逐渐上升,但瑞芬太尼组波动较舒芬太尼组更为明显。两组SBP和DBP于T1–T5时有显著性差异,HR于T1、T2和T5时有显著性差异(P<0.05)。两组麻醉时间、意识消失时间、意识消失时异丙酚剂量和异丙酚总剂量无显著性差异(P>0.05);舒芬太尼组自主呼吸恢复时间、呼之睁眼时间、拔管时间和定向力恢复时间均明显长于瑞芬太尼组(P<0.05),VAS评分显著高于瑞芬太尼组,镇痛药使用率及并发症发生率明显低于瑞芬太尼组(P<0.05)。OAA/S评分两组间比较差异无统计学意义(P>0.05)。结论与瑞芬太尼相比,舒芬太尼复合异丙酚麻醉用于急性心肌梗死镇痛患者,血流动力学更加平稳,术后苏醒质量更优,并发症更少,值得临床推广应用。

Objective To explore the efficacy of sufentanil and propofol for analgesia in patients with acute myocardial infarction（AMI）. Methods According to the random number table, 118 AMI patients were divided into sufentanil group and remifentanil group, with 59 in each group. The initial target effect concentrations of sufentanil and remifentanil were 0.25ng/ml and 2ng/ml respectively, and both of them were combined with propofol, initial target plasma concentration of which was 2μg/ml,with an increase of 0.5μg/ml every 2min till the loss of consciousness. Hemodynamic changes at pre-anesthesia induction（T0）, preintubation（T1）, immediately after intubation（T2）, 2min after intubation（T3）, end of operation（T4）, and extubation（T5）, and anesthetic condition, awakening time, postoperative analgesic effect, and complications were compared between two groups. Results Systolic blood pressure（SBP） and diastolic blood pressure（DBP） were lowered at T0-T2 in both groups, and they gradually rose at T2-T5. HR was lowered at T0-T1, and it rose gradually at T1-T5, but SBP and DBP fluctuation was more obvious in remifentanil group than in sufentanil group, with a significant difference at T1-T5, and a significant difference in HR at T1, T2 and T5（P〈0.05） between two groups. There was no significant difference between two groups in anesthesia time, awakening time, propofol dose, and total dose of propofol during loss of consciousness（P〉0.05）. The time for recovery of spontaneous breathing, time for eyeopening, upon calling, time of extubation and orientation recovery time were significantly longer in the sufentanil group than those in the remifentanil group（P〈0.05）. VAS score was significantly higher in sufentanil group than in remifentanil group（P〈0.05）, but analgesic use rate of the latter and incidence of complications were significantly lower in sufentanil group than in remifentanil group（P〈0.05）. No significant difference in OAA/S score was found between two groups（P〉0.05）. Conclusion As compared with remifentanil, sufentanil combined with propofol is used for analgesia in AMI patients resulting in more stable hemodynamics, better postoperative awakening quality, and fewer complications, thus it is worthy of wider clinical use.