舒芬太尼与芬太尼用于小儿先心病手术的对比研究

【目的】研究比较舒芬太尼与芬太尼在小儿先心病手术中对血流动力学、血浆儿茶酚胺的影响。【方法】选取心功能Ⅰ～Ⅱ级，无严重肝肾功能疾患的先心病患儿40例，随机分为芬太尼组（F组，n=20）和舒芬太尼组（S组，n=20）。F组麻醉诱导时给予芬太尼20μg／kg，划皮前、体外转流前分剐追加芬太尼10μg／kg；S组麻醉诱导时给予舒芬太尼2μg／kg，术中静脉持续输注舒芬太尼2μg／（kg·h），体外转流期间1μg／（kg·h）。在麻醉诱导后（T0）、开胸前（T1）、体外转流30min（T2）和停体外转流2h（T3）等时点记录心率（HR）、平均动脉压（MAP）监测值，并在T1、T2、T3等时点采血测定血浆多巴胺及乳酸含量。【结果】F组与S组麻醉效果均较满意，但T0时点心率均明显下降；S组T1、T3时点的心率下降更为明显（P〈0．05）；F组在T2时点乳酸水平升高较S组明显（P〈0．05）。【结论】舒芬太尼与等效剂量的芬太尼均能有效抑制血浆儿茶酚胺的释放，可以安全应用于小儿先心病手术的麻醉。

Comparative Study of Sufentanil and Fentanyl for Children with Congenital Heart Disease Undergoing Surgery

Objective] To compare the effects of sufentanil and fentanyl on hemodynamics and plasma catecholamine levels in children undergoing heart surgery. Methods] Forty patients withⅠ-Ⅱ heart function and normal liver and kidney were randomly divided into sufentanil group（S group, n = 20） and fentanyl group（F group, n = 20）. At the time of anesthesia induction, fentanyl 20μg/kg was injected intravenously in F group, and then pre-ineision and precardiopulmonary bypass （CPB）, fentanyl 10μg/kg was injected intravenously again. Sufentanil 2μg/kg was injected intravenously in S group at the time of anesthesia induction, and then sufentanil 2μg/kg/hr was continually injected intravenously during operation, and sufentanil 1μg/kg/hr was continually injected during CBP. Heart rate （HR）, SAP, DAP and MAP were recorded after anesthesia induction （T0）, before opened chests （T1）, 30min after cardiopulmonary bypass （T2）, 2 hours after cardiopulmonary bypass （T3）, and plasma lactate and catecholamine levels were measured at T1, T2 and T3. Results]The anesthesia was well tolerated for the two groups, and HR was all reduced significantly in To. In S group, HR was reduced significantly in T, and T3 （ P value 〈 0.05）, and plasma lactate levels were elevated significantly in F group more than that in S group at T2 （ P 〈0.05）. Conclusion]Sufentanil or equivalent dose of fentanyl can effectively control the release of catecholamine and can be safely used in children undergoing heart surgery.