| 温小林,李河志,李朝明,涂 涛,朱涤非.不同剂量舒芬太尼对心脏瓣膜置换术患者应激反应、炎性因子及心肌损伤的影响[J].,2020,(1):162-166 |
| 不同剂量舒芬太尼对心脏瓣膜置换术患者应激反应、炎性因子及心肌损伤的影响 |
| Effects of Different Doses of Sufentanil on Stress response, Inflammatory Factors and Myocardial Injury in Patients Undergoing Cardiac Valve Replacement |
| 投稿时间：2019-04-21 修订日期：2019-05-20 |
| DOI：10.13241/j.cnki.pmb.2020.01.036 |
| 中文关键词: 剂量 舒芬太尼 心脏瓣膜置换术 应激反应 炎性因子 心肌损伤 |
| 英文关键词: Dose Sufentanil Cardiac valve replacement Stress response Inflammatory factors Myocardial injury |
| 基金项目:四川省科技计划项目（2015JY0377） |
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| 中文摘要: |
| 摘要 目的：探讨不同剂量舒芬太尼对心脏瓣膜置换术患者应激反应、炎性因子及心肌损伤的影响。方法：根据随机数字表法将100 例行心脏瓣膜置换术的患者分为低剂量组（n=33，舒芬太尼剂量为1.0 μg/kg）、中剂量组（n=33，舒芬太尼剂量为1.5 μg/kg）以及高剂量组（n=34，舒芬太尼剂量为2.0 μg/kg），比较三组患者应激反应、炎性因子、心肌损伤等指标的变化以及围术期指标情况。结果：中剂量组、高剂量组麻醉诱导后（T1）、插管后1 min（T2）、插管后5 min（T3）、插管后10 min（T4）时间点心率（HR）、平均动脉压（MAP）均低于低剂量组同时间点，且高剂量组低于中剂量组（P<0.05）。与低剂量组比较，中剂量组、高剂量组阻断后30 min（T6）、开主动脉后2h（T7）以及术后1d（T8）时间点白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）均降低（P<0.05）。与低剂量组比较，中剂量组、高剂量组体外循环停机2h（T9）、体外循环停机8h（T10）、体外循环停机24h（T11）、体外循环停机48h（T12）时间点心肌肌钙蛋白I（cTnI）、肌酸磷酸激酶同工酶（CK-MB）均降低（P<0.05）。低剂量组、中剂量组重症监护室（ICU）滞留时间、拔管时间显著短于高剂量组（P<0.05），而三组心血管不良事件发生率比较差异无统计学意义（P>0.05）。结论：给予1.0 μg/kg舒芬太尼麻醉的患者应激反应小，1.5 μg/kg、2.0 μg/kg舒芬太尼可更好地控制心脏瓣膜置换术患者炎性反应，同时对患者心肌损伤有一定的保护作用，但2.0 μg/kg舒芬太尼会延长患者ICU滞留时间、拔管时间。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the effects of different doses of sufentanil on stress response, inflammatory factors and myocardial injury in patients undergoing cardiac valve replacement. Methods: 100 patients undergoing cardiac valve replacement were divided into low dose group (n=33, sufentanil dose was 1.0 μg/kg), middle dose group (n=33, sufentanil dose was 1.5 μg/kg) and high dose group (n=34, sufentanil dose was 2.0 μg/kg). The changes of stress response, inflammatory factors, myocardial injury and perioperative indexes were compared in the three groups. Results: Heart rate (HR) and mean arterial pressure (MAP) were lower in middle-dose group and high-dose group than in low-dose group at the same time point after induction of anesthesia (T1), 1 minute after intubation (T2), 5 minutes after intubation (T3), 10 minutes after intubation (T4), and the high dose group was lower than that of the middle dose group(P < 0.05). Compared with the low dose group, the levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in the middle dose group and the high dose group decreased at 30 minutes after blockade (T6), 2 hours after aortic occlusion (T7) and 1 day after operation (T8) (P<0.05). Compared with the low dose group, the cardiac troponin I (cTnI) and creatine phosphokinase isoenzyme (CK-MB) decreased in the middle dose group and the high dose group at cardiopulmonary bypass shutdown for 2h (T9), cardiopulmonary bypass shutdown for 8h (T10), cardiopulmonary bypass shutdown for 24h (T11) and cardiopulmonary bypass shutdown for 48h (T12) time points (P<0.05). The detention time of ICU and extubation time in low dose group and middle dose group were significantly shorter than those in high dose group (P<0.05). There was no significant difference in the incidence of adverse cardiovascular events in the three groups (P>0.05). Conclusion: Anesthesia with 1.0 μg/kg sufentanil has less stress reaction. 1.5 μg/kg and 2.0 μg/kg sufentanil can better control the inflammatory reaction in patients undergoing heart valve replacement and has a protective effect on myocardial injury, but 2.0 μg/kg sufentanil can prolong ICU detention time and extubation time. |
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