王琰

[摘要] 目的 探讨舒芬太尼在心脏手术麻醉中对血流动力学和应激反应的影响。 方法 将我院2014年10月～2015年6月心血管内科收治的在体外循环下实施心脏手术的40例先天性心脏病患儿分为观察组（30例）和对照组（10例），并根据用药剂量的不同将观察组分为A组（1 μg/kg，n=15）和B组（2 μg/kg，n=15），记录各组不同时间点的平均动脉压（MAP）、心率（HR）、中心静脉压（CVP）、血浆肾上腺素（E）和去甲肾上腺素（NE）指标，分析三组血流动力学和血浆儿茶酚胺的变化。 结果 与术前比较，三组患者麻醉诱导后HR均有所降低，其中观察组下降幅度较对照组更为明显，B组下降幅度较A组更为明显，差异有统计学意义（P<0.05）；气管插管后，观察组HR升高幅度小于对照组，差异有统计学意义（P<0.05）；三组患者麻醉诱导后MAP均有所降低，其中观察组下降幅度小于对照组，差异有统计学意义（P<0.05）。与基础值比较，三组NE浓度在主动脉开放后均有所升高，手术结束时均有所降低，其中观察组升降幅度更为明显，差异有统计学意义（P<0.05）。 结论 舒芬太尼应用于心脏手术，麻醉诱导效果显著，有助于维持患者循环系统的稳定性，其中大剂量用药在降低应激反应方面作用更为突出，小剂量用药则更有利于术后早期拔管。

[关键词] 心脏手术；麻醉药物；舒芬太尼；血流动力学；应激反应

[中图分类号] R726.1 [文献标识码] A [文章编号] 1674-4721（2016）02（b）-0107-03

Effect of Sufentanil on undergoing hemodynamic and stress responses of cardiac surgery patients

WANG Yan

Department of Anesthesiology，Zhengzhou Central Hospital Affiliated to Zhengzhou University，Zhengzhou 450007，China

[Abstract] Objective To explore the effect of Sufentanil on undergoing hemodynamic and stress responses of cardiac surgery patients. Methods 40 cases of congenital heart disease who were under cardiopulmonary bypass cardiac surgery in our hospital from October 2014 to June 2015 were selected as the researcher object，they were divided into observation group （30 cases） and control group （10 cases），and according to the dose，observation group was divided into different group A （1 μg/kg，n=15） and group B （2 μg/kg，n=15），and then MAP，HR，CVP and E and NE indicators of different time points were recorded，and hemodynamics and plasma catecholamine changes were analyzed. Results Compared with the preoperative，three groups′HR decreased after induction of anesthesia，observation group′s decline was more obvious than control group，group B′s decline was more obvious than group A，the difference was significant （P<0.05）；after endotracheal intubation，the observation group′s HR increased rate was lower than the control group，the difference was significant （P<0.05）； three groups′MAP all decreased after induction of anesthesia，the observation group 's decline level was lower than the control group，and the differenceIt was significant （P<0.05）.Compared with baseline，the three groups′norepinephrine concentration all increased after aortic open surgery，their norepinephrine all decreased at the end of srugey，which observation group′s lifting range was more obvious，the difference was significant （P<0.05 ）. Conclusion In cardiac surgery，Sufentannil has a good effect in Anesthesia inducing，can help to maintain the stability of the circulatory system of patients，and large doses of medication in reducing the stress response negative effect is more prominent，small doses of medication are more conducive to early extubation.

[Key words] Cardiac surgery；Narcotic drugs；Sufentanil；Hemodynamics；Stress reaction

舒芬太尼是目前临床应用最为广泛、镇痛作用最强的人工合成的阿片类药物，明确其在心脏手术麻醉中的最佳剂量，可为临床应用提供更为可靠的理论依据和具体指导[1-2]。本研究选取我院2014年10月～2015年6月心血管内科收治的择期行手术治疗的40例先天性心脏病患者作为研究对象，旨在探讨舒芬太尼在心脏手术麻醉中对血流动力学及应激反应的影响，现报道如下。

1资料与方法

1.1一般资料

以我院2014年10月～2015年6月期间，心血管内科拟行先天性心脏病矫正术患儿40例作为研究对象，所有患者经X线、超声心动图及心血管造影等检查并确诊，均符合先天性心脏病相关诊断标准[3]，排除术前肝肾功能不全、血流动力学紊乱以及存在体循环低灌注的患儿。……