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

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T3 MAP、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。

Effects of sufentanil, remifentanil or fentanyl on stress responses of patients during induction of general anesthesia

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 T0 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 significantlyincreased at T1 than T, and returned to baseline at T2 and T3. The MAP and HR in group R at T1 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 T1, 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 normal 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.