舒芬太尼对重症先天性心脏病患儿体外循环后氧代谢的影响

目的 评价舒芬太尼对重症先天性心脏病患儿体外循环(CPB)后氧代谢的影响.方法 择期在CPB下行心脏畸形根治术的重症先天性心脏病患儿34例,ASA Ⅲ级,年龄5～35月,体重5～15 kg,随机分为2组(n=17):芬太尼组(F组)和舒芬太尼组(S组).麻醉诱导:静脉注射咪达唑仑0.2 mg/kg、哌库溴铵0.2 mg/kg,F组静脉注射芬太尼10μg/kg,S组静脉注射舒芬太尼1μg/kg,气管插管后机械通气.麻醉维持:间断静脉注射咪达唑仑0.5～1 mg/kg、哌库溴铵0.2～0.5 mg/kg,F组静脉输注芬太尼20～30μg·kg-1·h-1,S组静脉输注舒芬太尼2～3 μg·kg-1·h-1.于CPB结束后15 min(T1)、术毕(T2)和术后24 h(T3)时,测定心排血量,计算心脏指数(CI),并取肺动脉血样,测定混合静脉血氧含量(C(v)O2);取桡动脉血样测定动脉血氧含量(CaO2),计算氧供指数(DO2I)、氧耗指数(VO2I)和氧摄取率(ERO2).结果 与F组比较,S组T2,3时DO,I和CI升高,各时点ERO2降低(P<0:05),VO2I差异无统计学意义(P>0.05).与T1时比较,F组T2,3时CI降低(P<0.05或0.01),其余指标各时点差异无统计学意义(P>0.05);S组各指标各时点差异无统计学意义(P>0.05).结论 舒芬太尼可改善重症先天性心脏病患儿CPB后机体氧代谢,维持氧供和氧耗平衡,其效果优于芬太尼.

Effects of sufentanil on oxygen metabolism after cardiopulmonary bypass in children with severe congenital heart disease

Objective To evaluate the effects of sufentanil on oxygen metabolism after eardiopulmonary bypass(CPB)in children with severe congenital heart disease undergoing open heart surgery.Methods Thirty-four children with severe congenital heart disease undergoing open heart surgery under CPB were randomly divided into 2 groups(n=17 each):sufentanil group(S)and fentanyl group(F).Anesthesia was induced with midazolam 0.2 mg/kg,pipecuronium 0.2 mg/kg and sufentanil 1μg/kg(in group S)/fentanyl 10μg/kg(in group F)and maintained with iv infusion of sufentanil(2-3μg·kg-1·h-1)(in group S)fentanyl(20-30μg·kg-1·h-1)(in group F)and intermittent iv boluses of midazolam and pipecuronium.The patients were mechanically ventilated after tracheal intubation.Swan-Ganz catheter was inserted through right internal jugular vein.Radial artery was cannulated.Arterial and mixed venous blood samples were taken at 15 min after termination of CPB(T1),the end of operation(T2)and 24 h after operation(T3)for measurement of cardiac out and blood ga8es.Cadiac index (CI),oxygen delivery index(DO2I),oxygen comumption index(VO2I)and oxygen extraction rate(ER02)were calculated.Results The CI and DO2I at T2,3 were significantly higher and ERO2 at T1,2,3 were significantly lower in group S than in group F.CI was significantly decreased at T2 and T3 as compared wit that at T1 in group F but CI at T1 was not significantly different from that at T2 and T3 in group S.Conclusionsufentanil is superior to fentanyl in maintaining the balance between oxygen delivery and consumption in children with severe congenital heart disease after open heart surgery with CPB.