舒芬太尼和芬太尼在老年人颅脑手术麻醉期间血流动力学及应激反应的比较

目的 比较舒芬太尼和芬太尼对老年人颅脑手术围手术期血流动力学、应激反应的影响。方法 选择40例年龄在60岁以上需在全麻下行颅脑手术的老年患者，ASAⅠ~Ⅱ级，随机等分为舒芬太尼组（S组，n=20）和芬太尼组（ F组，n=20）。插管后用微量泵持续静脉输入舒芬太尼（S组）或芬太尼（F组）。插管后用微量泵持续静脉输入舒芬太尼（S组）或芬太尼（F组），舒芬太尼组0.5μg﹒kg-1﹒h-1，芬太尼组4μg﹒kg-1﹒h-1。两组均复合持续泵入异丙酚，分次静脉注射维库溴铵维持肌松。在硬脑膜打开之后均停止给舒芬太尼和芬太尼。观察两组于麻醉诱导前（T0）、诱导后2min气管插管前（T1）、气管插管后1min（T2）、切头皮时（T3）、钻颅骨时（T4）、气管拔管时（T5）的平均动脉压(MAP)、心率（HR）以及这几个时点肘静脉血血浆皮质醇（Cor）和血糖（BG）浓度。结果 S组T1与T0比较MAP、HR显著下降（P<0.01或P<0.05）。F组T1与T0比较MAP、HR均明显下降（P<0.01或P<0.05）。 T2～T5 与T0比较，F组MAP、HR上升明显（P<0.05），而S组则无显著性差异（P>0.05）。MAP、HR T2~T5组间比较，F组显著升高（P<0.05）。S组各时点血浆皮质醇和血糖浓度无显著性差异（P>0.05），F组在T2、T3、T4、T5四个时点血浆皮质醇和血糖浓度较T0时明显升高（P<0.05）。S组较F组麻醉后苏醒时间和拔管时间明显缩短（P<0.05）。结论 舒芬太尼可以更好的抑止手术应激引起的血流动力学和激素水平的变化，维持循环系统的稳定。

Effect comparison between sufentanil and fentanyl on hemodynamics and stress in geratics neurosurgery operation

objective To compare effects of sufentanil with fentanyl on geratics in neurosurgery operations. Methods Forty ASA grade Ⅰ-Ⅱ geratics ,acheduled for neurosurgery operations,were randomly divided into two groups.Group sufentanil(Group S):combining sufentanil with propofol;group fentanyl(Group F) :combining fentanyl with propofol .The items observed were perioperative hemodynamics,plasma corticotrophin and blood glucose levels.Results In group S, MAP and HR were decreased significantly(P<0.05 or P<0.01) in 2 min after induction.And no statistical changes occurred afterward (P>0.05). In group F ,MAP and HR were significantly decreased(P<0.05or P<0.01). In group F ,MAP and HR were higher than those in group S(P<0.05)on T2-T5.The plasma corticotrophin and blood glucose levels were higher than those in group S. The patients in S group had a shorter time of awakening and to extubate than the F group(P<0.05). Conclusion Comparing with the equipotent dosage of fentanyl,sufentanil has less hemodynamic changes and minor stress reaction on geratics in neurosurgery operations.