舒芬太尼对高血压患者全麻诱导应激反应的影响

    Effects of different target concentrations of sufentanil on the stress response to general anestbesia of hypertension patients tracheal intubation

    • 摘要: 目的: 观察不同浓度舒芬太尼对高血压患者全麻诱导期应激反应的影响。方法: 全麻高血压患者60例,术前控制血压在一定范围内1周,随机均分为S1、S2、S3 3组,舒芬太尼血浆靶浓度分别为0.2、0.4和0.6 ng/ml。比较麻醉诱导各时段的血流动力学、脑电双频谱指数(BIS)、血浆肾上腺素(E)及去甲肾上腺素(NE)浓度。结果: 3组平均动脉压(MAP)、心率(HR)与T0比较,S2组和S3组在T1时刻MAP、HR均下降(P < 0.05~P < 0.01);S1组在T2、T3、T4时刻MAP、HR均明显升高(P <0.01),S3组在T3、T4时刻MAP、HR均明显降低(P < 0.01)。BIS与T0比较,3组在各时间点BIS值均降低(P < 0.01),其中S2组在T1、T2、T3、T4时刻变化范围在45~55之间,S1组在T1、T2、T3、T4时刻变化范围高于55,显示麻醉过浅,而S3组在各时点均低于45,显示麻醉过深。S2组插管后各时点血浆E、NE浓度差异均无统计学意义,S3组T2、T3时血浆E浓度低于S1组(P < 0.05~P < 0.01)。结论: 舒芬太尼靶控输注血浆靶浓度为0.4 ng/ml,能明显减轻高血压患者全麻诱导应激反应。

       

      Abstract: Objective: To study the effect of different target concentrations of sufentanil on the stress response to the hypertension patients tracheal intubation during induction of general anesthesia. Methods: Sixty hypertension patients were randomly divided into three groups with 20 cases each. Each group received a sufentanil target concentration(STC) of 0.2 ng/ml(S1),0.4 ng/ml(S2) and 0.6 ng/ml(S3),respectively. Mean arterial pressure(MAP),heart rate(HR),and bispectral index(BIS) were recorded at the time points of record baseline(T0),immediately before intubation(T1),immediately after intubation(T2),1 min after intubation(T3),3 min after intubation(T4). Results: Compared to T0 point,Map and HR of S2 and S3 were decreased(P < 0.05-P < 0.01); MAP and HR of S2 were all significant increased at T2,T3,T4 point(P < 0.01), and of S3 at T3,T4 were signicantly decreased. Compared with T0 point,BIS value of three groups were all decresed(P < 0.01),in which were in 45-55 range at T1,T2,T3,T4 of S2. BIS value of S1 were higher than 55 and of S3 were lower than 45,indicating too shallow or deep anesthesia. Comparison of norepinephrine (NE) concentration:T0 compared,S1,S2,S3 at each time point was no significant difference(P > 0.05). Comparison with epinephrine(E) concentration:compared with T0,T3 of S1 was higher(P < 0.05). T3,T4 of S3 were always lower than S1(P < 0.05-P < 0.01),the difference was statistically significant. Conclusions: The hemodynamic response to the hypertension patients during induction of general anesthesia is stable as the target concentration of 0.4 ng/ml.

       

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