瑞芬太尼联合小剂量舒芬太尼快通道麻醉对小儿心脏手术后C反应蛋白和降钙素原的影响

目的探讨瑞芬太尼联合小剂量舒芬太尼快通道麻醉对小儿心脏手术后C反应蛋白(CRP)和降钙素原(PCT)的影响。方法选择2015年8月至2018年5月在我院行房间隔缺损或室间隔缺损修补手术的52例患儿作为研究对象,采用随机数字表法将患儿分为2组,每组26例。B组采用瑞芬太尼快通道麻醉,A组采用瑞芬太尼联合舒芬太尼快通道麻醉。观察两组体外循环时间、术后拔管时间、重插管率、ICU滞留时间、术前(T_0)、术毕(T_1)、术后3 h (T_2)、术后6 h (T_3)、术后12 h (T_4)、术后24 h (T_5)血浆皮质醇(COR)、促肾上腺皮质素(ACTH)、PCT、CRP水平。结果两组体外循环时间、术后拔管时间、重插管率、ICU滞留时间相比较差异均无统计学意义(P>0.05)。两组T_1、T_2、T_3、T_4、T_5时ACTH、COR、PCT、CRP水平高于T_0时,且A组ACTH、COR、CRP水平低于B组(P<0.05)。两组T_1~T_5时PCT水平比较差异无统计学意义(P>0.05)。结论瑞芬太尼联合小剂量舒芬太尼快通道麻醉可降低小儿先天性心脏病术后的应激水平。

Effects of remifentanil combined with low-dose sufentanil fast-track anesthesia on C-reactive protein and procalcitonin in children after cardiac surgery

Objective To investigate the effects of remifentanil combined with low-dose sufentanil fast-track anesthesia on C-reactive protein and procalcitonin in children after cardiac surgery.Methods Totally 52 children with atrial septal defect(ASD)or ventricular septal defect(VSD)repaired in our hospital from August 2015 to May 2018 were selected as the study subjects,and the children were divided into group A and group B by random number table method,26 cases in each group.The remifentanil fast-track anesthesia was used in group B,and remifentanil combined with sufentanil fast-track anesthesia was used in group A.The cardiopulmonary bypass time,extubation time,re-intubation rate,ICU retention time,and plasma cortisol(COR),adrenocorticotropin(ACTH),procalcitonin(PCT),and C-reactive protein(CRP)levels before operation(T0)and at 0 h(T1),3 h(T2),6 h(T3),12 h(T4)and 24 h(T5)after operation were observed.Results There was no significant difference in cardiopulmonary bypass time,extubation time,re-intubation rate or ICU retention time between the two groups(P>0.05).The levels of ACTH,COR,PCT and CRP at T1,T2,T3,T4 and T5 were significantly higher than those at T0,and the levels of ACTH,COR and CRP at T1,T2,T3,T4 and T5 in group A were significantly lower than those in group B at the same time(P<0.05).There was no significant difference in PCT level between the two groups at T1~T5(P>0.05).Conclusion The remifentanil combined with low-dose sufentanil fast-track anesthesia can reduce the stress level of children with congenital heart disease after surgery.