不同剂量舒芬太尼对非体外循环冠状动脉旁路移植术患者围术期血糖及术后恢复的影响

Effects of different doses of sufentanil on perioperative blood glucose levels and postoperative recovery in patients with off-pump coronary artery bypass grafting

目的探讨不同剂量舒芬太尼对非体外循环冠状动脉旁路移植术(OPCABG)患者围术期血糖水平及术后恢复的影响。方法回顾性收集本院2018年9月至2021年8月行OPCABG的患者病历资料,最终纳入统计分析的患者312例。根据是否行快通道麻醉将患者分为传统麻醉组(n=160,舒芬太尼剂量>3μg·kg^(-1))和快通道麻醉组(n=152,舒芬太尼剂量<2μg·kg^(-1))。记录患者的一般情况、术前血糖值、麻醉和手术时间、搭桥支数,术中液体出入量和麻醉药用量,以及术后拔管时间、ICU停留时间、术后住院时间,并比较2组围术期不同时间点的血糖、乳酸水平及术中胰岛素应用情况。结果与传统麻醉组相比,快通道麻醉组舒芬太尼用量显著减少(P<0.01),七氟烷用量显著增加(P<0.01),咪达唑仑和丙泊酚用量无显著差异(P>0.05)。快通道麻醉组术后拔管时间显著短于传统麻醉组(P<0.01),ICU停留时间及术后住院时间组间比较无显著差异(P>0.05)。快通道麻醉组手术中、术毕、术后2~4 h和术后4~8 h的血糖水平显著高于传统麻醉组(P<0.05或P<0.01),术后2~4 h的乳酸水平显著高于传统麻醉组(P<0.05)。结论在OPCABG中,给予小剂量舒芬太尼会缩短拔管时间,但对患者ICU停留时间及术后住院时间没有影响,且可能会造成术中应激上调。

AIM To investigate the effects of different doses of sufentanil on perioperative blood glucose levels and postoperative recovery in patients with off-pump coronary artery bypass grafting(OPCABG).METHODS The date of patients receiving OPCABG in our hospital from September 2018 to August 2021 were retrospectively collected and finally 312 patients were included in the statistical analysis.The patients were divided into two groups according to whether they received fast-track anesthesia:traditional anesthesia group(n=160,dosage of sufentanil>3μg·kg^(-1))and fast-track anesthesia group(n=152,dosage of sufentanil<2μg·kg^(-1)).The general situation,preoperative blood glucose,anesthesia and operation time,bypass number of patients,the intraoperative fluid volume and dosage of anaesthetic,postoperative extubation time,and length of ICU stay and postoperative hospital stay were recorded.And the perioperative blood glucose,lactic acid levels at different time points as well as the intraoperative insulin use in the two groups were compared.RESULTS Compared with the traditional anesthesia group,the dosage of sufentanil in the fast-track anesthesia group was reduced(P<0.01),the dosage of sevoflurane was increased(P<0.01),and there was no significant differences in the dosage of midazolam and propofol(P>0.05).The postoperative extubation time in the fast-track anesthesia group was significantly shortened compared with the traditional anesthesia group(P<0.01),but there were no significant differences in length of ICU stay and postoperative hospital stay between the two groups(P>0.05).The intraoperative and postoperative blood glucose levels as well as 2-4 h and 4-8 h after surgery in the fast-track anesthesia group were significantly higher than the traditional anesthesia group(P<0.05 or P<0.01),so was the lactic acid level at 2-4 h after surgery(P<0.05).CONCLUSION In OPCABG,low-dose sufentanil can shorten extubation time,but has no effect on length of ICU stay and postoperative hospital stay,therefore,it may cause intraoperative stress upregulation.