不同剂量芬太尼与舒芬太尼对高血压患者无痛支气管镜麻醉效果

目的比较不同剂量芬太尼与舒芬太尼在高血压患者支气管镜检查中对应激反应的抑制效应。方法 133例行支气管镜检查的高血压患者,随机分为三组:芬太尼2μg/kg(F2组,n=44),芬太尼4μg/kg(F4组,n=43),舒芬太尼0.4μg/kg(S组,n=46)。各组诱导时先分别给予芬太尼2μg/kg、芬太尼4μg/kg、舒芬太尼0.4μg/kg,随后缓慢推注丙泊酚1 mg/kg;意识消失后给予司可林1 mg/kg,肌肉松弛后置入喉罩,镜检开始;术中丙泊酚25~75μg/(kg.min)持续泵入维持麻醉。记录诱导前(T1)、诱导后插入喉罩前(T2)、置入喉罩时(T3)、支气管镜过声门时(T4)、过声门后2 min(T5)、灌洗刷检和活检或支气管扩张时刻(T6)患者的SBP和HR。记录患者术中SpO2变化和T3、T4、T6时刻呛咳和体动。结果与T1比,三组患者SBP在T2时刻均明显下降(P<0.05),F2组T3、T4明显升高(P<0.05);与F2组比较,F4和S组SBP在T3、T4明显降低(P<0.05)。F2组患者在时刻呛咳及体动发生率明显高于F4和S组(P<0.05)。结论芬太尼4μg/kg及舒芬太尼0.4μg/kg均能很好的抑制高血压患者在支气管镜检查中的心血管应激反应。

Effects of different doses of fentanyl and sufentanil on stress response in hypertensive patients during bronchoscopy

Objective To compare the inhibitive effects of different doses of fentanyl and sufentanil in hypertensive patients during bronchoscopy on stress response.Methods 133 patients undergoing bronchoscopy with hypertension were randomly assigned int three groups: group F2(Fentanyl 2 μg/kg,n=44),group F4(Fentanyl 4 μg/kg,n=43),group S(Sufentanil 0.4 μg/kg,n=46).Patients in the three groups was firstly injected intravenously with fentanyl 2 μg/kg,fentanyl 2 μg/kg,sufentanil 0.4 μg/kg,respectively,followed by 1 mg/kg propofol by I.V slowly,After the loss of consciousness,1 mg/kg succinylcholine was infused.Laryngeal mask was not inserted until muscle relaxation.Then begin the procedure.Propofol were continuously infused at a rate of 25~75 μg·kg-1·min-1 to maintain anesthesia.SBP,DBP and HR were recorded before induction(T1),after induction and before laryngeal mask insertion(T2),laryngeal mask insertion(T3),bronchoscope through glottis(T4),2 min after bronchoscope through glottis(T5),during lavage,biopsy and dilation of bronchus(T6).In the meantime,SpO2,cough and body movement at T3,T4,T6 were also observed and recorded.Results SBP,DBP at T2 in three groups were decreased significantly(P<0.05),and increased at T3,T4.F2 group increased more significantly than the other two groups(P<0.05).The cases of cough and body movement in group F2 was more markedly than the other two groups at T3,T4(P<0.05),But there was no statistically significant difference among the three groups at T6(P>0.05).No significant difference was seen in HR among the three groups(P>0.05).Moreover,oxygen saturation below 95% has not been observed in all patients during the bronchoscopy.Conclusion Both fentanyl 4 μg/kg and sufentanil 0.4 μg/kg can inhibit the cardiovascular stress response of hypertensive patients during bronchoscopy.