不同剂量芬太尼对心脏手术心肌保护作用的影响

张运淳; 陈启旭; 陈兰仁; 林学武

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不同剂量芬太尼对心脏手术心肌保护作用的影响

张运淳 , 陈启旭 , 陈兰仁 , 林学武

文章导航 > 蚌埠医学院学报 > 2006, 31 > 5: (461-463)

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不同剂量芬太尼对心脏手术心肌保护作用的影响

蚌埠医学院附属医院麻醉科, 安徽蚌埠 233004

作者简介: 张运淳(1964-),男,副主任医师,讲师.

中图分类号: R654.2;R971.2

Effects of different dosages of fentanyl on plasma cardiac troponin-I and management of fast track cardiac anesthesia in patients undergoing open heart surgery

Department of Anesthesiology, Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
CLC number: R654.2;R971.2

摘要: 目的: 比较不同剂量芬太尼复合丙泊酚在心肺转流(cardiao pulmonary bypass,CPB)心内直视手术中对心肌肌钙蛋白I(cTn-I)及快通道管理的影响。方法: 选择30例行房间隔缺损或室间隔缺损修补术的先天性心脏病患者,随机分为三组:A、B和C组,每组10例,芬太尼用量为A组15 μg/kg、B组30 μg/kg、C组50 μg/kg,三组均复合丙泊酚2~4 mg·kg^-1·h^-1静脉持续输注。分别于手术前(T₁)、开放主动脉即刻(T₂)、开放主动脉30 min(T₃)、CPB停机4 h(T₄)及24 h(T₅)5个时点抽取桡动脉血测定血浆cTn-I浓度,监测心电图(ECG)、平均动脉压(MAP)、中心静脉压(CVP)、脉搏血氧饱和度(SpO₂)以及呼气末二氧化碳分压(P_ETCO₂)、鼻咽温和直肠温,记录术后清醒时间、拔管时间和ICU停留时间。结果: 与术前比较,三组患者血浆cTn-I浓度在T₃、T₄和T₅时点均显著升高(P<0.01);于T₄时点达峰值,T₅时点开始下降;组间比较B组和C组比A组低(P<0.01);B组和C组间差异无统计学意义(P>0.05)。术后清醒时间以A组为最短(P<0.05),B组和C组间差异无统计学意义(P>0.05);拔管时间A、B两组均短于C组(P<0.01和P<0.05),A、B两组间差异无统计学意义(P>0.05);ICU停留时间A、B、C三组虽呈增高趋势,但差异无统计学意义(P>0.05)。结论: 在心肺转流心内直视手术中,芬太尼用量30 μg/kg复合丙泊酚2~4 mg·kg^-1·h^-1是较为理想的具有心肌保护作用和快通道实施的临床用药剂量。
- 心脏外科学 /
- 芬太尼 /
- 心肺转流术 /
- 肌钙蛋白I /
- 快通道
Abstract: Objective: To compare the effects of different dosages of fentanyl combined with propofol on plasma cardiac troponin-I(cTn-I) and management of fast track cardiac anesthesia(FTCA) in patients undergoing open heart surgery with cardiopulmonary bypass(CPB).Methods: Thirty patients,scheduled for undergoing atrioseptopexy or ventriseptopexy were randomly divided into three fentanyl dosage groups,ten patients each group.Fentanyl of 15 μg/kg was administered in group A,30 μg/kg in group B and 50 μg/kg in group C.Three groups were combined with intravenous infusion of propofol 2 to 4 mg·kg^-1·h^-1.The radial artery blood samples were collected to measure the plasma concentration of cTn-I before operation(T₁),at the onset of aorta unclamping(T₂),30 min after aorta unclamping(T₃),4 h after weaning from CPB(T₄) and 24 h after weaning from CPB(T₅).ECG,HR,BP,CVP,SpO₂,PETCO₂,and body temperature(naso-pharyngeal and rectal) were continuously monitored during operation.Time of emergence from anesthesia and exlubation and the duration of stay in ICU were recorded.Results: The plasma concentration of cTn-I was increased significantly in three groups at T₃,T₄ and T₅ compared with those at(T₁)(P<0.01) and reached the peak level at T₄ then was decreased at T₅.cTn-I values in group B.Group C were lower than those in group A(P<0.01).There were no significant differences between group B and C(P>0.05).Time of emergence from anesthesia were significantly shorter in group A than in group B and C(P<0.05).Time of extubation were significantly shorter in group A and B than in group C(P<0.01 and P<0.05).The duration of stay in ICU showed a tendency of increase but there were no significant differences in three groups(P>0.05).Conclusions: Fentanyl 30 μg/kg combined with propofol 2 to 4 mg·kg^-1·h^-1 is suitable for protecting the myocardium from reperfusion injury and managemant of FTCA.
- heart surgery /
- fentanyl /
- cardiopulmonary bypass /
- troponin-I /
- fast-track

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不同剂量芬太尼对心脏手术心肌保护作用的影响

作者简介: 张运淳(1964-),男,副主任医师,讲师.

蚌埠医学院附属医院麻醉科, 安徽蚌埠 233004

收稿日期: 2006-07-04

关键词:

摘要: 目的: 比较不同剂量芬太尼复合丙泊酚在心肺转流(cardiao pulmonary bypass,CPB)心内直视手术中对心肌肌钙蛋白I(cTn-I)及快通道管理的影响。方法: 选择30例行房间隔缺损或室间隔缺损修补术的先天性心脏病患者,随机分为三组:A、B和C组,每组10例,芬太尼用量为A组15 μg/kg、B组30 μg/kg、C组50 μg/kg,三组均复合丙泊酚2~4 mg·kg^-1·h^-1静脉持续输注。分别于手术前(T₁)、开放主动脉即刻(T₂)、开放主动脉30 min(T₃)、CPB停机4 h(T₄)及24 h(T₅)5个时点抽取桡动脉血测定血浆cTn-I浓度,监测心电图(ECG)、平均动脉压(MAP)、中心静脉压(CVP)、脉搏血氧饱和度(SpO₂)以及呼气末二氧化碳分压(P_ETCO₂)、鼻咽温和直肠温,记录术后清醒时间、拔管时间和ICU停留时间。结果: 与术前比较,三组患者血浆cTn-I浓度在T₃、T₄和T₅时点均显著升高(P<0.01);于T₄时点达峰值,T₅时点开始下降;组间比较B组和C组比A组低(P<0.01);B组和C组间差异无统计学意义(P>0.05)。术后清醒时间以A组为最短(P<0.05),B组和C组间差异无统计学意义(P>0.05);拔管时间A、B两组均短于C组(P<0.01和P<0.05),A、B两组间差异无统计学意义(P>0.05);ICU停留时间A、B、C三组虽呈增高趋势,但差异无统计学意义(P>0.05)。结论: 在心肺转流心内直视手术中,芬太尼用量30 μg/kg复合丙泊酚2~4 mg·kg^-1·h^-1是较为理想的具有心肌保护作用和快通道实施的临床用药剂量。

English Abstract

Effects of different dosages of fentanyl on plasma cardiac troponin-I and management of fast track cardiac anesthesia in patients undergoing open heart surgery

Department of Anesthesiology, Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China

Received Date: 2006-07-04

Abstract: Objective: To compare the effects of different dosages of fentanyl combined with propofol on plasma cardiac troponin-I(cTn-I) and management of fast track cardiac anesthesia(FTCA) in patients undergoing open heart surgery with cardiopulmonary bypass(CPB).Methods: Thirty patients,scheduled for undergoing atrioseptopexy or ventriseptopexy were randomly divided into three fentanyl dosage groups,ten patients each group.Fentanyl of 15 μg/kg was administered in group A,30 μg/kg in group B and 50 μg/kg in group C.Three groups were combined with intravenous infusion of propofol 2 to 4 mg·kg^-1·h^-1.The radial artery blood samples were collected to measure the plasma concentration of cTn-I before operation(T₁),at the onset of aorta unclamping(T₂),30 min after aorta unclamping(T₃),4 h after weaning from CPB(T₄) and 24 h after weaning from CPB(T₅).ECG,HR,BP,CVP,SpO₂,PETCO₂,and body temperature(naso-pharyngeal and rectal) were continuously monitored during operation.Time of emergence from anesthesia and exlubation and the duration of stay in ICU were recorded.Results: The plasma concentration of cTn-I was increased significantly in three groups at T₃,T₄ and T₅ compared with those at(T₁)(P<0.01) and reached the peak level at T₄ then was decreased at T₅.cTn-I values in group B.Group C were lower than those in group A(P<0.01).There were no significant differences between group B and C(P>0.05).Time of emergence from anesthesia were significantly shorter in group A than in group B and C(P<0.05).Time of extubation were significantly shorter in group A and B than in group C(P<0.01 and P<0.05).The duration of stay in ICU showed a tendency of increase but there were no significant differences in three groups(P>0.05).Conclusions: Fentanyl 30 μg/kg combined with propofol 2 to 4 mg·kg^-1·h^-1 is suitable for protecting the myocardium from reperfusion injury and managemant of FTCA.