不同剂量舒芬太尼对全麻诱导双腔支气管插管时心血管反应的影响

目的观察不同剂量舒芬太尼对全麻诱导患者行双腔支气管插管时血流动力学的影响，并探讨最佳剂量。方法选取我院2010年9月至2011年2月择期行肺叶切除术或食管癌根治术的患者60例，ASAI～Ⅱ级，年龄30～60岁，随机分为三组（每组20例）：舒芬太尼0．4μg／kg（SF1）组、0．6μg／kg（SF2）组、0．8μg／k9（SF3）组。各组患者均行双腔支气管插管，于注射丙泊酚及维库溴铵前注射相应剂量的舒芬太尼。记录患者进入手术室后全麻诱导前（T0）、诱导后（T1）、插管即刻（T2）、插管后1min（L3）、3min（T4）、5min（T5）各时点收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）。结果三组患者年龄、性别、身高、体重、ASA分级、T0时血压、心率差异均无统计学意义（P〉0．05）；T，与T0比较各参数均下降（P〈0．05），T，时SB组SBP及MAP下降幅度大于SFl及SF2组（P〈0．05）；T2时各参数较T1均升高（P〈0．05），SFW组T2时各参数均高于T0（P〈0．05），SF2组各参数变化平稳（P〉0．05），SF3组T2时SBP、MAP及HR均低于T0（P〈0．05）；L、T4、T5三组各参数均较T2下降，SF1组各参数T5已恢复至T0水平，SF2组及SF3组各参数T5时均低于T0（P〈0．05），其中SF3组各参数下降幅度较大。结论在双腔支气管插管时，SF1、SF2、SF3组均可有效地减轻双腔管插管反应，其中SF2组效果最佳。

Effects of different doses of sufentanil on cardiovascular response to intubation with double - lumen tubes during induction of anesthesia

Objective To observe the effects of different doses of sufentanil on hemodynamic response during intubation with double -lumen tubes, and to determine the optimal dose for intubation. Methods Sixty ASA I -III patients undergoing elective pulmonary lobectomy or operation for esophageal carcinoma were chosen in Zhongnan hospital. Patients were randomly divided into three groups with 20 cases each ： group sufentanil O. 4 μg/kg （ SFI ） ,0.6 μg/kg （ SF2 ）, and 0.8 μG/kg （ SF3 ）. A bolus dose of sufentanil 0. 4,0.6 or 0.8μg/kg was given over 60 seconds in groups SF1 ,SF2 and SF3 before injection of propofol and vecuronium. The systolic blood pressure（ SBP）, diastolic blood pressure（DBP） , mean arterial blood pressure （MAP） and heart rate （HR） were recorded before induction （ To ）, after drug injection （ T1 ） , during intubation（T2） ,and at 1 min（T3 ） ,3 min（T4） and 5 min（Ts） after intubation. Results There was no difference in patients＇age, sex, body height, body weight, ASA grading, basal BP or HR （ P 〉 0. 05 ）. The parameters at T1 were all lower than T0（P 〈0.05）. The SBP and MAP in group SF1 ,SF2 were higher than those in group SF3 at T1. The parameters at T2 were higher than those at T1 （P 〈 0. 05）, and were increased compared with To in group SF1 , relatively stable in group SF2 , and lower than To in group SF3 except DBP（P 〈0.05）. The parameters at T3 ,T4 ,T5 in 3 groups were relatively lower than those at T2 ,and the parameters in group SF3 at Ts were lower than To （P 〈 0.05）. Conclusion The three doses of sufentanil could be used in intubation with double -lumen tubes to effectively inhibit cardiovascular response, and the dose of group SF2 has optimal effect.