舒芬太尼、瑞芬太尼、芬太尼对全麻患者气管插管时心血管反应的影响

目的观察舒芬太尼、瑞芬太尼、芬太尼全麻诱导期患者气管插管时心血管反应,以及血浆血管紧张素(AngⅡ)、肾素活性(PRA)和醛固酮(ALD)水平变化,了解这三种药物对全麻诱导期患者气管插管时心血管反应的影响,为临床上选择全麻诱导期患者气管插管用药提供临床依据。方法将60例择期全麻手术患者随机分为芬太尼组、瑞芬太尼组、舒芬太尼组,每组各20例,分别采用芬太尼、瑞芬太尼和舒芬太尼行麻醉诱导。于诱导前、插管后3min记录收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR),并同时抽取静脉血,用高效液相色谱法测定血浆血管紧张素(AngⅡ)、肾素活性(PRA)和醛固酮(ALD)水平。结果芬太尼组、瑞芬太尼组插管后3min的SBP、DBP、MAP、HR和插管前相比显著升高(p<0.05),舒芬太尼组插管后3min的SBP、DBP、MAP、HR和插管前相比无显著差异(p>0.05)。芬太尼组、瑞芬太尼组插管后3min的AngⅡ、PRA、ALD和插管前相比显著升高(p<0.05),舒芬太尼组插管后3min的AngⅡ、PRA、ALD和插管前相比无显著差异(p>0.05)。结论舒芬太尼抑制插管时应激反应的效果优于瑞芬太尼和芬太尼,瑞芬太尼和芬太尼抑制插管时应激反应的效果相当,舒芬太尼更有利于血流动力学和肾素-血管紧张素系统(RAS)的稳定。

EFFECT OF SULFENTANYL,REMIFENTANIL AND FENTANYL ON CARDIOVASCULAR EFFECTS OF GENERAL ANESTHESIA CASE WHEN TRACHEA CANNULA

Objective To observe the cardiovascular effects of sulfentanyl, remifentanil and fentanyl on case of general anesthesia derivative phase when trachea cannula, and to the change of the level changes of angiotensin - II （Ang II ） , renin activity（PRA） and aldosterone（ALD） , and to understand cardiovascular effects of three drugs on case of general anesthesia derivative phase when trachea cannula and to provid clinic evidence of choosing the drugs for general anesthesia derivative phase when trachea cannula. Methods 60 cases received the selective operation with general anesthesia were divided into the sulfentanyl group, remifentanil group and fentanyl group with 20 cases in each group. The cases in each group were with induction of anesthesia by sulfentanyl, remifentanil and fentanyl respectively. The SBP, DBP, MAP and HR were recorded before induction of anesthesia and in 3 minutes after cannu- la. And the venous blood were abstract, the level of angiotensin - II, renin activity and aldosterone were determine by high efficiency liquid chromatography. Results The SBP, DBP, MAP and HR in remifentanil group and fentanyl group in 3 minutes after cannula were higher than those before induction of anesthesia（p 〈 0. 05）. The SBP, DBP, MAP and HR in sulfentanyl group in 3 minutes after cannula were same to those before induction of anesthesia （p 〉 0. 05）. The Ang I1, PRA and ALD in remifentanil group and fentanyl group in 3 minutes after cannula were higher than those before induction of anesthesia（p 〈0. 05）. The Ang II ,PRA,ALD in sulfentanyl group in 3 minutes after cannula were same to those before induction of anesthesia （p 〉0. 05）. Conclusion The effect of sulfentanyl in restrain the stress reaction when trachea cannula is superior to that of remifentanil and fentanyl. And the effect of remifentanil in restrain the stress reaction when trachea cannula is same to that of fentanyl. So the sulfentanyl is help to the stabilization of hemodynamics and the RAS.