舒芬太尼复合七氟烷小剂量丙泊酚麻醉在非体外冠脉搭桥术中的应用

目的探讨舒芬太尼复合七氟烷和小剂量丙泊酚静吸复合全麻在非体外循环冠脉搭桥术（off-pump coronary artery bypass graft,OPCABG）中的应用。方法选择符合条件的非体外循环冠脉搭桥手术患者70例,随机分为两组（n=35）,舒芬太尼组（S组）和芬太尼组（F组）,S组予以舒芬太尼、七氟烷复合小剂量的丙泊酚,F组予以芬太尼、七氟烷复合小剂量的丙泊酚进行静吸复合全麻,观察两组插管前（T0）、插管后（T1）、劈胸骨（T2）、搭回旋支（T3）及穿钢丝（T4）时血流动力学的变化。结果两组平均动脉压（MAP）在T1、T2、T4等强刺激时均升高（P〈0.05）,且F组较S组升高更显著（P〈0.05）;两组心率（HR）在T1～T4各时点均显著升高（P〈0.05）,但组间比较无显著性差异（P〉0.05）;两组混合静脉血氧饱和度（SvO2）在T3时均明显降低（P〈0.05）,但组间比较差异无显著性（P〉0.05）;S组血压反应和心率明显波动的发生率明显低于F组（P〈0.05）。结论舒芬太尼、七氟烷复合小剂量丙泊酚静吸复合全麻具有更稳定的血流动力学效应,对病人的循环干扰小,是OPCABG的一个良好的选择。

Application of Sulfentanil Compound with Sevoflurane Inhalation and Low Dose Propofol Anesthesia in Off-Pump Coronary Artery Bypass Graft Surgery

Objective To observe the clinical effects of intravenous-inhalation combined anesthesia with sulfentanil compound with low dose propofol and sevoflurane in off-pump coronary artery bypass graft surgery(OPCABG).Methods 40 patients with ASA Ⅱ~Ⅲ undergoing OPCABG were randomly divided into sulfentanil group(Group S) and fentanil group(Group F),and were separated given sulfentanil or fentanil compound with propfol and sevoflurane to perform intravenous-inhalation combined anesthesia.Hemodynamic parameters were recorded at time point of pre-intubation(T0),catheterization(T1),sternum splitting(T2),vasotransplantation(T3) and steel wire countersinked(T4).Results The MAPs of two groups were significantly increased at T1,T2 and T4(P<0.05),but the MAPs of group F were higher than that of the group S at every time point of T1 to T4(P<0.05).The HRs were obviously increased at every time point of T1 to T4 in both two groups(P<0.05),but there was no difference of HR between two groups(P>0.05).The SvO2 of both two groups were decreased at T3(P>0.05),while there was no difference between two groups(P>0.05).The incidence rate of adverse cardiac events of group S was remarkable lower than that of group F(P<0.05).Conclusion It shows a good hemodynamic effect with slightly circulation disturbs of the sulfentanil,propofol intravenous anesthesia compound with sevoflurane inhalation anesthesia,and may be a good choice for OPCABG.