舒芬太尼与芬太尼对成人二尖瓣瓣膜置换术心肌肌钙蛋白Ⅰ的影响对比
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摘要
目的：比较临床常用等效剂量的舒芬太尼与芬太尼用于成人体外循环心脏手术的心肌保护作用差异。
方法：选择风湿性心脏瓣膜病变需接受二尖瓣瓣膜置换术的成人患者20名,根据阿片药物用药的不同随机分为两组：芬太尼组(F组,n=10)和舒芬太尼组(S组,n=10)。两组阿片药物均采用持续静脉输注方式,根据手术操作步骤及患者循环情况调整输注速度,维持MAP在60-80mmHg。从麻醉开始到主动脉阻断即刻,F组芬太尼用量为35μg/kg,S组舒芬太尼用量为5μg/kg；主动脉阻断至主动脉开放即刻,F组芬太尼用量为14μg/kg,S组舒芬太尼用量为2μg/kg；主动脉开放即刻至手术结束,F组芬太尼用量为10μg/kg,S组舒芬太尼用量为1.4μg/kg。两组分别于麻醉诱导前(T0)、CPB开始前(T1)、主动脉开放30min(T2)、CPB停机4h(T3)、CPB停机24h(T4)各时点抽取静脉血,检测心肌肌钙蛋白I (cTnI)术中连续记录心率(HR)、平均动脉压(MAP)等血流动力学参数以及转流时间、主动脉阻断时间、手术时间。
结果：两组cTnI在T0时均在正常范围,无显著性差异(p>0.05)；Tl时较T0时均升高(p<0.05),两组间无显著性差异(p>0.05)；T2、T3、T4时均明显升高,较T0时差异非常显著(p<0.01),F组较S组明显升高,具有显著性差异(p<0.05)。
结论：与等效剂量芬太尼比较,舒芬太尼用于成人体外循环心脏手术具有更好的心肌保护作用。
Objective:To compare the clinical common equivalent dose of sufentanil and fentanyl whether the existence of myocardial protection through detecting perioperative changes of cardiac troponin I in adult mitral valve replacement.
Methods:Select 20 adult patients with rheumatic mitral valve disease required to undergo valve replacement, according to the different opioid drugs they were randomly divided into fentanyl group (F group,n=10) and sufentanil group (S group,n=10).Both groups were given continuous intravenous infusion method. To maintain MAP at about 60-80mmHg and adjust the infusion rate according to operative procedure and patients with circulation. From starting the anaesthesia to aortic clamping, total dose of fentanyl was 35μg/kg, sufentanil reached a total of 5μg/kg; From aortic clamping to immediate moment of aortic opening, total dose of fentanyl was 14μg/kg, and sufentanil was 2μg/kg;from aottic opening to the end of surgery, total dose of fentanyl was 10μg/kg,and sufentanil was 1.4μg/kg.The surgery. Blood samples were collected in both groups respectiveiy before induction of anesthesia(To), before the CPB(T1), aortic opening 30min(T2), CPB stop 4h(T3), CPB stop 24h(T4),then the cTnI in plasma of all blood sample was tested.In surgery, the heart rate (HR), mean arterial pressure (MAP) and other hemodynamic parameters、bypass time、aortic cross clamp time and operation time were recorded.
Results:CTnI at To, both groups were within the normal range, no significant difference (p> 0.05);T1 were higher when compared with To, (p<0.05), the two groups showed no significant difference (p> 0.05); T2, T3, T4 were higher when compared with To, there was a significant difference (p<0.01),F group was significantly higher than the S group, with significant difference (p<0.05).
Conclusion:Compared with equivalent doses of fentanyl, sufentanil used in adult cardiopulmonary bypass has better myocardial protection.
方法：选择风湿性心脏瓣膜病变需接受二尖瓣瓣膜置换术的成人患者20名,根据阿片药物用药的不同随机分为两组：芬太尼组(F组,n=10)和舒芬太尼组(S组,n=10)。两组阿片药物均采用持续静脉输注方式,根据手术操作步骤及患者循环情况调整输注速度,维持MAP在60-80mmHg。从麻醉开始到主动脉阻断即刻,F组芬太尼用量为35μg/kg,S组舒芬太尼用量为5μg/kg；主动脉阻断至主动脉开放即刻,F组芬太尼用量为14μg/kg,S组舒芬太尼用量为2μg/kg；主动脉开放即刻至手术结束,F组芬太尼用量为10μg/kg,S组舒芬太尼用量为1.4μg/kg。两组分别于麻醉诱导前(T0)、CPB开始前(T1)、主动脉开放30min(T2)、CPB停机4h(T3)、CPB停机24h(T4)各时点抽取静脉血,检测心肌肌钙蛋白I (cTnI)术中连续记录心率(HR)、平均动脉压(MAP)等血流动力学参数以及转流时间、主动脉阻断时间、手术时间。
结果：两组cTnI在T0时均在正常范围,无显著性差异(p>0.05)；Tl时较T0时均升高(p<0.05),两组间无显著性差异(p>0.05)；T2、T3、T4时均明显升高,较T0时差异非常显著(p<0.01),F组较S组明显升高,具有显著性差异(p<0.05)。
结论：与等效剂量芬太尼比较,舒芬太尼用于成人体外循环心脏手术具有更好的心肌保护作用。
Objective:To compare the clinical common equivalent dose of sufentanil and fentanyl whether the existence of myocardial protection through detecting perioperative changes of cardiac troponin I in adult mitral valve replacement.
Methods:Select 20 adult patients with rheumatic mitral valve disease required to undergo valve replacement, according to the different opioid drugs they were randomly divided into fentanyl group (F group,n=10) and sufentanil group (S group,n=10).Both groups were given continuous intravenous infusion method. To maintain MAP at about 60-80mmHg and adjust the infusion rate according to operative procedure and patients with circulation. From starting the anaesthesia to aortic clamping, total dose of fentanyl was 35μg/kg, sufentanil reached a total of 5μg/kg; From aortic clamping to immediate moment of aortic opening, total dose of fentanyl was 14μg/kg, and sufentanil was 2μg/kg;from aottic opening to the end of surgery, total dose of fentanyl was 10μg/kg,and sufentanil was 1.4μg/kg.The surgery. Blood samples were collected in both groups respectiveiy before induction of anesthesia(To), before the CPB(T1), aortic opening 30min(T2), CPB stop 4h(T3), CPB stop 24h(T4),then the cTnI in plasma of all blood sample was tested.In surgery, the heart rate (HR), mean arterial pressure (MAP) and other hemodynamic parameters、bypass time、aortic cross clamp time and operation time were recorded.
Results:CTnI at To, both groups were within the normal range, no significant difference (p> 0.05);T1 were higher when compared with To, (p<0.05), the two groups showed no significant difference (p> 0.05); T2, T3, T4 were higher when compared with To, there was a significant difference (p<0.01),F group was significantly higher than the S group, with significant difference (p<0.05).
Conclusion:Compared with equivalent doses of fentanyl, sufentanil used in adult cardiopulmonary bypass has better myocardial protection.
引文
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