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舒芬太尼、瑞芬太尼、芬太尼对全麻诱导期机体应激反应的影响 被引量:36

Effects of sufentanil,remifentanil or fentanyl on stress responses of patients during induction of general anesthesia
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摘要 目的:观察舒芬太尼、瑞芬太尼、芬太尼用于全麻诱导对机体应激反应和血液动力学的影响。方法:60例择期全麻手术患者,根据诱导时辅用镇痛药物的不同,按随机、双盲方法分为舒芬太尼(S)组、瑞芬太尼(R)组和芬太尼(F)组。分别于诱导前(T,基础值)、插管前即刻(T0)、插管后1 min(T1)、3 min(T2)、5 min(T3)记录收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)、SpO2,并在各时点抽取静脉血,用高效液相色谱法测定血浆去甲肾上腺素(NE)和肾上腺素(E)的浓度。结果:T0时三组的MAP、HR和T时相比显著降低(P<0.05或P<0.01),且R组下降幅度高于F、S组。F组:T1时的MAP、HR明显高于T时,亦高于相同时点的R、S组(P<0.01),于T2、T3时刻恢复至基础水平。R组:T1时的MAP、HR与T时相比无统计学差异(P>0.05),但从T1到T3MAP、HR呈持续下降趋势,至T2、T3时已明显低于T时,有2例HR达55次/分。S组MAP、HR在T、T1、T2、T3时的比较,差异无统计学意义。NE和E浓度除F组在T1、T2时高于基础值(P<0.05或P<0.01),其余各时点间比较,差异无统计学意义(P>0.05)。结论:和芬太尼相比,瑞芬太尼和舒芬太尼均能有效抑制插管时应激反应,同时舒芬太尼更有利于血流动力学稳定。 Objective: To compare the effects of sufentanil, remifentanil or fentanyl on hemodynamic and stress responses of patients during induction of general anesthesia. Methods: In a randomized, double-blind study, sixty ASA Ⅰ - Ⅱ patients undergoing elective abdominal surgery under general anesthesia were divided into sufentanil group (S, n = 20), remifentanil group (R, n = 20) and fentanyl group (F, n = 20). SBP, DBP, MAP, HR and SpO2 were recorded before induction of anesthesia (T, baseline), immediately after tracheal intubation (T0), 1, 3 and 5minutes after intubation(T1, T2, T3 ). At the same time, plasma norepinephrine(NE) and epinephrine(E) were determined by high performance liquid chromatography. Results: The MAP and HR in three groups at To were significantly lower than those at T, and decreased much greatly in group R than in group F and S. The MAP and HR in group F significantly increased at TI than T, and returned to baseline at Tz and T3. The MAP and HR in group R at TI were not significantly different from those at T, but gradually decreased; the levels at T2, T3 were significantly lower than at baseline and in group F or S. Compared with the baseline, the MAP and HR in group S at T1, T2, T3 remained unchanged. In group R, there were two patients whose HR were under 55· min^- 1. In group F, the plasma NE and E at TI, T2 were significantly higher than those at T. In group R and S, there were no significant changes in plasma NE and E, which were all within nomml range. Conclusion: Both sufentanil and remifentanil effectively inhibit the stress response during induction of general anesthesia. At the same time, sufentanil has better hemodynamic stability.
出处 《山东大学学报(医学版)》 CAS 北大核心 2006年第10期1032-1035,共4页 Journal of Shandong University:Health Sciences
关键词 舒芬太尼 瑞芬太尼 芬太尼 血流动力学 应激 Sufentanil Remifentanil Fentanyl Hemodynamic Stress
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参考文献10

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