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

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1.0μg/kg)、中剂量组(n=33,舒芬太尼剂量为1.5μg/kg)以及高剂量组(n=34,舒芬太尼剂量为2.0μg/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1.0μg/kg舒芬太尼麻醉的患者应激反应小,1.5μg/kg、2.0μg/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2.0μg/kg舒芬太尼会延长患者ICU滞留时间、拔管时间。

Effects of Different Doses of Sufentanil on Stress response, Inflammatory Factors and Myocardial Injury in Patients Undergoing Cardiac Valve Replacement

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(c Tn I) and creatine phosphokinase isoenzyme(CK-MB) decreased in the middle dose group and the high dose group at cardiopulmonary bypass shutdown for 2 h(T9), cardiopulmonary bypass shutdown for 8 h(T10), cardiopulmonary bypass shutdown for 24 h(T11) and cardiopulmonary bypass shutdown for 48 h(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 2.0μg/kg sufentanil can prolong ICU detention time and extubation time.