不同剂量舒芬太尼对心脏瓣膜置换术患者应激反应的影响

目的探讨不同剂量舒芬太尼对心脏瓣膜置换术患者围术期应激反应的影响。方法30例心脏瓣膜置换术患者，随机分为三组即S1组（舒芬太尼总量3μg／kg）、S2组（舒芬太尼总量5μg／kg）和S组（舒芬太尼总量10μg／k）。分别于麻醉前（T0）、开胸后5min钟（T1）、阻断后30min（T2）、开主动脉后2h（T3）和术后24h（T4）各时间点测定动脉血中血糖、皮质醇的含量，并记录三组患者在ICU的停留时间和拔管时间。结果三组患者的血糖、血浆皮质醇在T，时无变化，在T2和T3各时间点均显著高于T0（P〈0．01或P〈0．05）。转流后同一时间点三组患者各指标以S1组最高，S组最低，且S2组和S3组在T2和T3时间点血糖、血浆皮质醇均明显低于S1组（P〈0．05），但S2组和S组比较差别无显著性，S3组患者ICU停留时间和术后拔管时间明显比S1组和S2组延长（P〈0．05）。结论舒芬太尼（3-10μg／kg）能完全抑制气管插管、CPB转流前手术操作所致的应激反应，但对CPB促发的应激反应不能完全抑制。其中，不同剂量比较发现，舒芬太尼在5μg／kg及10μg／kg时，对应激的平抑效果优于3μg/kg，达一定剂量后不随剂量增加而增加，反使患者拔管时间和术后ICU停留时间延长。因此，5μg/kg可认为是较为理想的剂量。

Effect of different doses of sufentanil on the stress in patients undergoing valve replacement during cardiopulmonary bypass

Objective To investigate the effects of different doses of sufentanil on the stress response in valve replacement surgery during cardiopulmonary bypass （CPB）. Methods Thirty adult patients undergoing valve replacement with cardiopulmonary bypass were randomly divided into 3 groups which were group S1 （sulfentanil 3 ug/kg）, and group S2 （sulfentanil 5ug/kg）, and group S3 （sulfentanil 10ug/kg）. Blood samples were taken before anaesthesia （T0）, 5 n-fin after opening the thorax （T1）, 30 min after aortic clamping （T2）, 2 h after aortic declamping （T3）, and 24 h （T4） after the operation to determine the plasma levels of glucose, and cortisol. The stage of ICU and the extubation time were recorded. Results The value levels of glucose and cortisol after the CPB （T2, T3 and T4 ） in 3 groups were significantly increased compared with that of To （P〈 0. 05 or P〈 0. 01）. After CPB, at the same time point, among the 3 groups, the value levels of the above index of group S1 were the most highest, that of group S3 were the most lowest. Glucose and cortisol value levels at T2 and T3 were significantly lower in Group S2 and S3 than those in Group St （P〈 0. 05）. But there were no significantly statistics differences between Group S2 and S3. The duration of stay in the ICU and time of endotraeheal extubation were remarkably longer in patients of group S3 than group S1 and S2 （P〈 0. 05）. Conclusion Sufentanil （3-10ug/kg） can completely suppress the stress response induced by intubation and intense surgical stimulus before CPB. Different doses of sufentanil seemed to be effective in reducing CPB-induced stress respons. But the effect was not dependent on dose. So 5ug/kg sufentanil seemed to be an ideal dose.