芬太尼对心血管应激反应和血浆心钠素水平的影响

Effect of Fentanyl on Stress Responses of Cardiovascular System and on ANP

目的 :探讨不同剂量的芬太尼对全麻气管插管时心血管应激和血浆心钠素 (ANP)分泌的影响。方法 :2 1例非心脏手术患者 (ASA -Ⅰ级 ,无心血管、肾和内分泌疾患 ) ,随机分为两组 ,GⅠ组 9例 (芬太尼 2 μg/kg) ,GⅡ组 12例 (芬太尼4 μg/kg)。于入室后静卧 (T0 )、麻醉诱导毕 (T1)、气管插管即刻 (T2 )、插管后 1min(T3 )、插管后 3min(T4)、插管后 5min(T5) 6个时相监测SBP、DBP、MAP和HR ,作为气管插管时心血管应激反应的指标 ,同时分别于T0 、T2 、T5取左肘正中静脉血测定血浆心钠素 (ANP)浓度。结果 :GⅠ组T2 、T3 血压、心率、ANP均明显升高 (P <0 0 1) ;GⅡ组T2 、T3 时血压升高 (P <0 0 5 ) ;心率、ANP均无明显升高 (P >0 0 5 )。结论 :芬太尼 4 μg/kg可有效地预防气管插管时的心血管应激反应 ,且血浆ANP浓度无明显升高。

Objective:To observe and investigate the effects of fentanyl induction on cardiovascular stress response and on atrial natriuretic polypeptide (ANP) response imposed on by tracheal intubation of general anesthesia.Methods:Twenty-one patients,aged 36-60 years and weighing 46-82kg were randomly divided into two groups:GI 9 patients received Feutanyl 2μg/kg,GⅡ 12 patients received Feutanyl 4μg/kg and both groups received other additional inducers (pancuronium,droperidol etomidate) in same dosage regimen.Systolic blood pressure (SBP),diastolic blood pressure,mean arterial pressure (MAP) and heart rate (HR) were measured by monitor at six phases (supinate rest on bed in operation room,immediately after anesthesia induction(T_1),at the moment of tracheal intubation(T_2),1 minute after intubation(T_3),3 minute after intubation(T_4) and 5 minute after intubation,and plasma ANP contents were determined at T_0,T_2 and T_5 phases by radioimmunoassay.Results:GI:The SBP,DBP,MAP,HR at T_2,T_3 were significantly higher than those at T_0 ( P <0.01);while the HP,ANP showed no significant difference ( P >0.05).Conclusions:The dose of fentanyl 4μg/kg is of protective action on stress response during tracheal intubation,however,the ANP is not effectively affected by fentanyl induction.