舒芬太尼与芬太尼对小儿心脏手术乳酸水平影响的回顾性研究

目的:通过对非发绀先天性心脏病(先心病)小儿心脏手术中乳酸水平的大样本回顾分析,对比舒芬太尼与芬太尼复合麻醉乳酸水平以及高乳酸血症的发生率。方法:选择我院2006年10月至2008年11月期间实施的新生儿、婴幼儿心脏手术405例,年龄11～1095d平均(353.72±249.84)d,美国麻醉医师学会(ASA)Ⅰ～Ⅱ级。根据麻醉方法分成芬太尼组(F组,210例)和舒芬太尼组(S组,195例)。2组均为静吸复合麻醉,诱导麻醉F组芬太尼5～l0μg/kg,S组舒芬太尼0.5～1μg/kg;维持麻醉F组芬太尼总量(50.43±30.41)μg/kg,S组舒芬太尼(9.12±4.44)μg/kg,2组均间断吸入异氟烷(0.5%～1%),静脉注入咪达唑仑和哌库溴铵。收集切皮前(T1)、体外循环心脏复跳后10min(T2)、体外循环结束后15min(T3)、ICU1h(T4)、ICU8h(T5)、ICU24h(T6)6个时间点动脉血乳酸值,比较2组各个时间点高乳酸血症(乳酸值≥3mmol/L)的发生率和乳酸值变化趋势。结果:全组T2点乳酸值明显高于其它各点(P0.01),并且与年龄、体质量呈明显负相关性,与手术时间、体外循环时间、阻断主动脉时间、拔气管导管时间及ICU停留时间等呈明显正相关性(P0.01)。S组年龄、体质量、手术时间、体外循环时间及阻断主动脉时间、拔气管导管时间及ICU停留时间与F组比较差异无统计学意义(P0.05)。S组T1、T2、T3及T4点乳酸值均明显低于F组(P0.01);S组T2、T3点高乳酸血症发生率明显低于F组(P0.05)。结论:手术中,与芬太尼比较,舒芬太尼能够降低乳酸水平,明显降低高乳酸血症发生率,对改善非发绀先心病小儿心脏手术中的乳酸代谢有明显积极作用。

Retrospective study of sufentanil and fentanyl on perioperative blood lactate level in infants undergoing cardiac surgery

Objective：To compare the effects of sufentanil and fentanyl on blood lactate retrospectively on non-cyanotic congenital heart disease infants undergoing cardiac surgery.Methods：A total of 405 infants undergoing elective cardiac surgery from October 2006 to December 2008 were recruited.The patients were divided into fentanyl group（group F,n = 210） and sufentanil group（group S,n = 195）according to anaesthetic method.Group F was induced with fentanyl 5-l0 μg/kg and maintained with（50.43 ± 30.41） μg/kg;Group S was induced with sufentanil（0.5-1） μg/kg and maintained with（9.12 ± 4.44） μg/kg.Isoflurane（0.5%-1%）,midazolam and pipecuronium were intermittently used during the surgery if necessary in both groups.Data of blood lactate were collected at the following points：before incision（T1）,10 min after heat rebeating（T2）,15min after cardiopulmonary bypass（T3）,1h after operation（T4）,8h after operation（T5） and 24h after operation（T6）.Incidence of hyperlactacidemia and variance trend of blood lactate of two groups were compared according to the data collected before.Results：Blood lactate on T2 were significantly higher than that of other points in both groups（P 0.01）and has negative correlation with age and weight,has positive correlation with the duration of sugery,CPB time,aortic-cross clamping time,extubation time and the duration of stay in intes-ive care unit（P 0.01）.There were no significant differences with respect to age,weight,the duration of sugery,CPB time,aortic-cross clamping time,extubation time and the duration of stay in intesive care unit between two groups（P 0.05）.Blood lactate in group S were significantly lower than group F on points T1-T4（P 0.01）.Incidence of hyperlactacidemia in group S were significantly lower than group F on T2 and T3（P 0.05）.Conclusion：Comparing with fentanyl,sufentanil can significantly decrease the incidence of hyperlactacidemia,and improve the lactate metabolism of the infants with non-cyanotic congenital cardiac disease undergoing cardiac surgery.