不同靶浓度舒芬太尼复合依托咪酯在瓣膜置换术患者全麻诱导中的应用

Effect of target effect-site concentration of sufentanil on hemodynamics stability during induction of etomidate anesthesia in patients undergoing elective cardiac valves replacement surgeries

目的:比较不同效应室靶浓度舒芬太尼对依托咪酯麻醉患者诱导期间血流动力学的影响。方法:择期全麻下行开胸心脏瓣膜置换术患者60例,随机分为3组,每组20例,Ⅰ组患者靶控输注舒芬太尼0.5 ng/m L,Ⅱ组患者靶控输注舒芬太尼0.7 ng/m L,Ⅲ组患者靶控输注舒芬太尼0.9 ng/m L,待舒芬太尼血浆和效应室靶浓度达到平衡后,静脉注射依托咪酯0.3 mg/kg,当脑电双频指数(BIS)值达到45~55时,静脉注射顺式阿曲库铵0.2 mg/kg,当4个成串刺激值等于0后行经口气管插管,记录患者入室(T1)、气管插管前(T2)、插管后即刻(T3)、插管后1 min(T4)、插管后3 min(T5)、插管后5 min(T6)患者的平均动脉压(MAP)、心率(HR)、每搏变异度(SVV)和心输出量(CO);记录各组患者血管活性药物的用量。结果:在T1时3组患者的MAP、HR和CO差异无统计学意义(P>0.05);与T1时点相比,3组患者T2~T6时点的MAP下降(P<0.05),Ⅲ组患者的MAP较Ⅰ和Ⅱ组患者下降幅度更大(P<0.05);Ⅰ和Ⅱ组患者在麻醉诱导后CO差异无统计学意义(P>0.05),Ⅲ组患者CO下降(P<0.05);Ⅲ组患者在麻醉诱导后HR下降(P<0.05);与Ⅰ组和Ⅱ相比,Ⅲ组患者阿托品、去甲肾上腺素、肾上腺素的使用量增加(P<0.05)。结论:0.5 ng/m L和0.7ng/m L舒芬太尼复合依托咪酯0.3 mg/kg用于心脏瓣膜置换术患者麻醉诱导效果较好。

Objective： To investigate the effect of target effect-site concentration of sufentanil on hemodynamics stability during induction of etomidate anesthesia in patients undergoing elective cardiac valves replacement surgeries. Methods： 60 patients scheduled for elective cardiac valve replacement surgery under general anesthesia were randomly divided into three groups,20 cases in each group. Patients in group I,group Ⅱ and group Ⅲ were given sufentanil by target controlled infusion 0. 5 ng/ml,0. 7 ng/ml and 0. 9 ng/ml respectively. MAP,HR,SVV and CO were recorded before induction（ T1）,before oral tracheal intubation（ T2）,and 0 min（ T3）,1 min（ T4）,3 min（ T5）,5 min（ T6） after oral tracheal intubation.The dosages of Vasoactive drugs were recorded. Results： MAP,HR and CO of the three groups before induction（ T1） had no statistical difference（ P〈0. 05）. MAP at T2 ～ T6 decreased significantly in the three groups（ P〈0. 05） and the decrease of MAP in group Ⅲ was higher than that in group I and group Ⅱ（ P〈0. 05）. CO in group Ⅲ decreased significantly after induction（ P〈0. 05）,while no significant change was found in group I and group Ⅱ（ P〈0. 05）. HR in group Ⅲ decreased after induction（ P〈0. 05）. Compared with group I and group Ⅱ,the higher dosage of atropine,norepinephrine and epinephrine were needed in group Ⅲ（ P〈0. 05）. Conclusion： In patients undergoing elective cardiac valve replacement surgery,0. 5 ng/ml or 0. 7 ng/ml sufentanil combined with 0. 3 mg/kg etomidate administrated during induction is helpful in maintaining the hemodynamics stability.