舒芬太尼与芬太尼在冠脉搭桥手术麻醉中应用的比较

目的比较舒芬太尼与芬太尼在冠脉搭桥术麻醉中血流动力学变化特点及两者间的等效剂量关系。方法将16例拟行冠脉搭桥术患者随机分成舒芬太尼组与芬太尼组。记录入室后、气管插管后、转机（搭桥）前、转机（搭桥）后、手术结束时各点血流动力学指标的变化平均动脉压（MAP）,中心静脉压（CVP）,MPAP,PCWP,CI,混合静脉氧饱和度（SvO2）,心率（HR）]。观察麻醉维持期间舒芬太尼与芬太尼的用量。结果两组血流动力学指标中,CVP在转机（搭桥）前舒芬太尼组较芬太尼组升高（7.7±3.4）vs.（4.9±2.0）mmHg],其余指标两组间无显著性差异。在麻醉诱导时,舒芬太尼的给药剂量为（1.3±0.6）μg/kg,芬太尼为（10.0±2.9）μg/kg;维持给药量两组分别为（0.7±0.1）μg/（kg·h）、（7.3±1.5）μg/（kg·h）;麻醉维持期间给药次数舒芬太尼组（2.7±0.5）次]少于芬太尼组（5.0±1.3）次]。结论舒芬太尼与芬太尼用于冠脉搭桥手术麻醉均使血流动力学变化稳定。使用单次推注方法维持麻醉时,舒芬太尼的等效剂量为芬太尼的1/8～1/10。

A comparison of sufentanil and fentanyl in general anesthesia in patients undergoing coronary artery bypass graft surgery

Objective To compare the effect s of sufentanil and fentanyl on the hemodynamics and equivalent dosages in patients undergoing coronary artery bypass graft surgery（CABG）. Methods 16 patients were assigned randomly into two groups（sufentanil group or fentanyl group）.Etomidate, pipercuronium bromide, sufentanil（or fentanyl） were used in induction. Continuous infusion propofol（60～100mg/h）＋isoflurane（0.6%～1.0%） inhalation were used to maintain anesthesia. Additional sufentanil or fentanyl was given to maintain the MAP which changed between 70～90mmHg. MAP, CVP, MPAP, PCWP, CI, SvO2, HR were recorded at the following points： before induction, two minutes after tracheal intubation, before pumping （or before bypass graft）, off-pumping （or after bypass graft）, the end of operation. Results No statistic difference was observed between the two groups except that CVP increased before pumping （or before bypass graft） in sufentanil group. Conclusions Both sufentanil and fentanyl may keep the hemodynamics stable in patients undergoing coronary artery bypass graft surgery. The equivalent dosage of sufentanil is about 1/8～1/10 of fentanyl during the maintaining of anesthesia in CABG.