高剂量瑞芬太尼与小剂量舒芬太尼在婴儿心脏快通道麻醉中的应用效果

Effect of high-dose remifentanil and low-dose sufentanil on fast-track cardiac anesthesia in infants

目的分析高剂量瑞芬太尼与小剂量舒芬太尼在婴儿心脏快通道麻醉(FTCA)中的应用效果,并观察其对血清激活素A(ACT-A)和N端B型利钠肽前体(NT-proBNP)水平的影响。方法选取2016年5月至2019年5月收治的86例先天性心脏病患儿作为研究对象,所有患儿均接受FTCA下行室间隔缺损(VSD)修补和(或)房间隔缺损(ASD)修补术。对全部先天性心脏病婴儿的病历资料进行回顾性分析,并且按照麻醉药物的不同分为对照组和观察组各43例。对照组以小剂量舒芬太尼(0.2~0.3μg·kg-1·min-1)进行麻醉,观察组则以高剂量瑞芬太尼(0.5~0.6μg·kg-1·min-1)进行麻醉,对比两组麻醉效果以及对ACT-A、NT-proBNP水平的影响。观察两组不同时间段平均动脉压(MAP)和心率(HR)变化,包括麻醉诱导前(T0)、劈胸骨(T1)、复温5 min(T2)、胸骨缝合(T3)、气管拔除(T4)5个时点。结果T0时两组MAP、HR对比无统计学差异(P均>0.05);两组T1、T2、T3、T4时MAP水平均高于T0时,观察组以上时点均低于对照组(P均<0.01);两组T1、T3、T4时HR水平均高于T0时,观察组以上时点均低于对照组(P均<0.01)。麻醉前两组ACT-A和NT-proBNP水平对比无统计学差异(P均>0.05);两组术后ACT-A和NT-proBNP水平较麻醉前明显降低(P均<0.01),观察组术后ACT-A水平低于对照组(P<0.05)。观察组术后睁眼、拔管、自主呼吸恢复时间早于对照组,病房留观时间短于对照组(P均<0.01)。结论在婴儿FTCA中实施高剂量瑞芬太尼与小剂量舒芬太尼均能取得良好效果,但高剂量瑞芬太尼能够更好的抑制应激反应的发生以及改善患儿手术预后。

Objective To analyze the effects of high-dose remifentanil and low-dose sufentanil on fast-track cardiac anesthesia(FTCA)in infant and their influences on the levels of serum activin A(ACT-A)and N-terminal pro-B-type natriuretic peptide(NT-proBNP).Methods The clinical data of 86 children with congenital heart disease under FTCA from May 2016 to May 2019 were analyzed retrospectively.All the children received VSD repair and/or ASD repair under FTCA.All infants were divided into control group and observation group according to the different anesthetic drugs(n=43,each).Anesthesia with low-dose sufentanil(0.2-0.3μg·kg-1·min-1)was performed in control group,while anesthesia with high-dose remifentanil(0.5-0.6μg·kg-1·min-1)was conducted in observation group.The effect of anesthesia and the levels of ACT-A and NT proBNP were compared between two groups.The changes of mean arterial pressure(MAP)and heart rate(HR)were observed at different time points,including before anesthesia induction(T0),at sternotomy(T1),rewarming for 5 min(T2),sternal suture(T3),tracheal extubation(T4)in two groups.Results There was no significant difference in MAP and HR between two groups at T0 point(all P>0.05);MAP levels of T1,T2,T3 and T4 were higher in the two groups than that of T0 point,and MAP levels of T1-T4 in observation group were lower than those in control group(all P<0.01);HR levels of T1,T3 and T4 were higher than that of T0 point,and HR levels of the above time points in observation group were lower than those in control group(all P<0.01).There were no significant differences in the levels of ACT-A and NT-proBNP between two groups before anesthesia(all P>0.05).Compared with before anesthesia,postoperative levels of ACT-A and NT-proBNP decreased significantly in two groups(all P<0.01),and ACT-A level of the observation group was lower than that of control group(P<0.05).In observation group,postoperative eye opening,extubation,and spontaneous breathing recovery were earlier than in control group,and the ward observation time was shorter than that in control group(all P<0.01).Conclusion Both high-dose remifentanil and low-dose sufentanil can achieve good results in infant undergoing FTCA,but high-dose remifentanil can better inhibit the occurrence of stress response and improve the prognosis.