摘要
目的探讨舒芬太尼对重症冠心病患者冠状动脉旁路移植术(CABG)后血流动力学的影响。方法选取100例重症冠心病患者,随机分为观察组51例和对照组49例,两组在CABG后均给予常规处理,观察组同时给予舒芬太尼镇痛,比较两组患者治疗前后血流动力学变化及并发症发生率。结果两组心率、中心静脉压(CVP)、平均动脉压、心排出量(CO)、外周循环阻力指数(SVRI)、肺循环阻力指数(PVRI)均有随时间变化的趋势(均P<0.05)。但治疗后12 h和24 h,观察组心率、SVRI、PVRI水平低于对照组,CO高于对照组(均P<0.05);治疗后12 h,观察组CVP水平低于对照组(P<0.05)。观察组术后机械通气时间短于对照组(P<0.05),但两组ICU停留时间以及术后急性心肌梗死、新发房颤、术后室颤、新发急性肾损伤和死亡的发生率比较,差异均无统计学意义(均P>0.05)。结论舒芬太尼可改善重症冠心病患者CABG后的心功能,减少血流动力学的波动,且不增加不良事件发生率。
Objective To investigate the effects of sufentanil on hemodynamics in the patients with coronary heart disease after coronary artery bypass grafting( CABG). Methods One hundred patients with severe coronary heart disease were randomly divided into observation group( 51 cases) and control group( 49 cases). Both groups received conventional treatment after CABG,besides,the control group was given sufentanil for analgesia. The hemodynamics changes and the incidence rate of complications after treatment were compared between the two groups. Results Heart rate,central venous pressure( CVP),mean arterial pressure( MAP),cardiac output( CO),systemic vascular resistance index( SVRI) and pulmonary vascular resistance index( PVRI) changed over time( all P < 0. 05). At 12 and 24 hours after treatment,heart rate,SVRI and PVRI were lower and CO was higher in the observation group than those in the control group( all P < 0. 05). At 12 hours after treatment,the level of CVP in the observation group was lower than that in the control group( P < 0. 05). The postoperative duration for mechanical ventilation in the observation group was shorter than that in the control group( P < 0. 05),but there were no significant differences between the two groups in the ICU stay,incidence rate of postoperative acute myocardial infarction,new-onset atrial fibrillation,postoperative ventricular fibrillation or new-onset acute kidney injury,or mortality( all P > 0. 05). Conclusion Sufentanil can improve cardiac function,contribute to stable hemodynamics and reduce the incidence rate of adverse events in the patients with severe coronary heart disease after CABG.
引文
[1]Barr J,Fraser GL,Puntillo K,et al.Clinical practice guidelines for the management of pain,agitation,and delirium in adult patients in the intensive care unit:executive summary[J].Am J Health Syst Pharm,2013,70(1):53-58.
[2]Lakdizaji S,Zamanzadeh V,Zia Totonchi M,et al.Impact of patient-controlled analgesia on pain relief after coronary artery bypass graft surgery:a randomized clinical trial[J].J Caring Sci,2012,1(4):223-229.
[3]Nigro Neto C,do Amaral JL,Arnoni R,et al.Intrathecal sufentanil for coronary artery bypass grafting[J].Braz J Anestesiol,2014,64(2):73-78.
[4]Eagle KA,Guyton RA,Davidoff R,et al.ACC/AHA 2004guideline update for coronary artery bypass graft surgery:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines(Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery)[J].Circulation,2004,110(9):1 168-1 176.
[5]Rijkenberg S,Stilma W,Bosman RJ,et al.Pain measurement in mechanically ventilated patients after cardiac surgery:comparison of the behavioral pain scale(BPS)and the critical-care pain observation tool(CPOT)[J].J Cardiothorac Vasc Anesth,2017,61(4):1 227-1 234.
[6]Doliszny KM,Luepker RV,Burke GL,et al.Estimated contribution of coronary artery bypass graft surgery to the decline in coronary heart disease mortality:the Minnesota Heart Survey[J].J Am Coll Cardiol,1994,24(1):95-103.
[7]Alavi SM,Ghoreishi SM,Chitsazan M,et al.Patient-controlled analgesia after coronary bypass:Remifentanil or sufentanil[J].Asian Cardiovasc Thorac Ann,2014,22(6):694-699.
[8]Fechner J,Ihmsen H,Schuettler J,et al.The impact of intra-operative sufentanil dosing on post-operative pain,hyperalgesia and morphine consumption after cardiac surgery[J].Eur J Pain,2013,17(4):562-570.
[9]Bhavsar R,Sloth E,Folkersen L,et al.Sufentanil preserves hemodynamics and left ventricular function in patients with ischemic heart disease[J].Acta Anaesthesiol Scand,2011,55(8):1 002-1 009.
[10]Pouraghaei M,Moharamzadeh P,Soleimanpour H,et al.Comparison between the effects of alfentanil,fentanyl and sufentanil on hemodynamic indices during rapid sequence intubation in the emergency department[J].Anesth Pain Med,2014,4(1):e14618.
