CAJ | 학술논문

目的：探讨不同剂量舒芬太尼诱导对房室间隔缺损修补术患儿血流动力学的影响。方法选择2012年10月~2013年5月玉林市第一人民医院房室缺修补术患儿80例为研究对象，将其随机均分为四组，依次静注咪达唑仑0.1 mg/kg，舒芬太尼(Ⅰ组0.6μg/kg，Ⅱ组0.8μg/kg，Ⅲ组1.0μg/kg ，Ⅳ组1.2μg/kg)，依托咪酯0.3 mg/kg和罗库溴铵0.6 mg/kg。记录诱导前﹙T0﹚、诱导后(T1)、插管后即刻(T2)、插管后2 min(T3)、插管后5 min(T4)、插管后10 min(T5)各时点的收缩压、心率及诱导期间心血管不良事件的发生率。结果四组患儿的年龄、性别、体重、身高、美国麻醉医师协会分级、心功能、房室缺例数比较差异无统计学意义(P>0.05)。T0时，四组患儿收缩压、心率比较，差异无统计学意义(P>0.05)；T1时，Ⅳ组收缩压显著低于Ⅰ组、Ⅱ组、Ⅲ组，差异有统计学意义(P<0.05)；T2时Ⅰ组、Ⅱ组收缩压、心率显著高于Ⅲ组和Ⅳ组(P<0.05)。与T0比较，T1时四组患儿收缩压、心率均显著减慢(P<0.05)；T2时Ⅰ组、Ⅱ组收缩压升高(P<0.05)；与T0时心率比较，Ⅰ组、Ⅱ组显著升高(P<0.05)，Ⅲ组无明显变化(P>0.05)，Ⅳ组仍显著降低(P<0.05)。麻醉诱导后及气管插管后各时点BIS与T0比较均显著下降(P<0.05)，相同时点组间比较差异无统计学意义(P>0.05)。诱导后Ⅳ组低血压、心动过缓的发生率显著高于Ⅰ、Ⅱ、Ⅲ组(P<0.05)，插管后Ⅰ、Ⅱ组高血压、心动过速的发生率显著高于Ⅲ、Ⅳ组(P<0.05)。结论舒芬太尼1.0μg/kg全麻诱导时气管插管反应较小。
목적：탐토불동제량서분태니유도대방실간격결손수보술환인혈류동역학적영향。방법선택2012년10월~2013년5월옥림시제일인민의원방실결수보술환인80례위연구대상，장기수궤균분위사조，의차정주미체서륜0.1 mg/kg，서분태니(Ⅰ조0.6μg/kg，Ⅱ조0.8μg/kg，Ⅲ조1.0μg/kg ，Ⅳ조1.2μg/kg)，의탁미지0.3 mg/kg화라고추안0.6 mg/kg。기록유도전﹙T0﹚、유도후(T1)、삽관후즉각(T2)、삽관후2 min(T3)、삽관후5 min(T4)、삽관후10 min(T5)각시점적수축압、심솔급유도기간심혈관불량사건적발생솔。결과사조환인적년령、성별、체중、신고、미국마취의사협회분급、심공능、방실결례수비교차이무통계학의의(P>0.05)。T0시，사조환인수축압、심솔비교，차이무통계학의의(P>0.05)；T1시，Ⅳ조수축압현저저우Ⅰ조、Ⅱ조、Ⅲ조，차이유통계학의의(P<0.05)；T2시Ⅰ조、Ⅱ조수축압、심솔현저고우Ⅲ조화Ⅳ조(P<0.05)。여T0비교，T1시사조환인수축압、심솔균현저감만(P<0.05)；T2시Ⅰ조、Ⅱ조수축압승고(P<0.05)；여T0시심솔비교，Ⅰ조、Ⅱ조현저승고(P<0.05)，Ⅲ조무명현변화(P>0.05)，Ⅳ조잉현저강저(P<0.05)。마취유도후급기관삽관후각시점BIS여T0비교균현저하강(P<0.05)，상동시점조간비교차이무통계학의의(P>0.05)。유도후Ⅳ조저혈압、심동과완적발생솔현저고우Ⅰ、Ⅱ、Ⅲ조(P<0.05)，삽관후Ⅰ、Ⅱ조고혈압、심동과속적발생솔현저고우Ⅲ、Ⅳ조(P<0.05)。결론서분태니1.0μg/kg전마유도시기관삽관반응교소。
Objective To evaluate the effects of different doses of Sufentanil on hemodynamic of children undergoing ASD and VSD surgery during anesthesia induction. Methods 80 children were randomly and equally allocated into four groups, Anesthesia was induced with intravenous injection of Midazolam 0.1mg/kg, Sufentanil (groupⅠ: 0.6 μg/kg, groupII:0.8μg/kg, groupⅢ:1.0μg/kg, groupⅣ:1.2μg/kg), Etomidate 0.3 mg/kg and Rocuronium 0.6 mg/kg. SBP, HR and cardiovascular events were recorded before induction of anesthesia (T0), after induction of anesthesia (T1), intubation (T2), after intubation 2 min (T3), 5 min (T4) and 10 min (T5). Results There were no significant difference in age, sex, weight, height, Classified by ASA, heart function and the number of patients with congenital heart disease between four groups (P> 0.05). SBP was significantly lower in group Ⅳ compared to the other groups at T1 (P< 0.05). SBP, HR in groupⅠ and II were significantly higher than those in group Ⅲ and Ⅳ at T2 (P< 0.05). Compared with T0, SBP, HR in groupⅠ,II,Ⅲ andⅣ were lower at T1 (P<0.05). Compared with T0, SBP、HR was higher in groupⅠ and II (P< 0.05), no significant difference in group Ⅲ (P> 0.05), lower in group Ⅳ at T2 (P< 0.05). Compared with T0, the BIS was lower in four groups at T2, T3, T4 and T5 (P<0.05). And there was no significant difference in BIS comparison among groups at the same time. The incidence of hypotension and bradyarrhythmia at T1 was significantly higher in groupⅣ than the other groups (P<0.05), and the incidence of hypertension and tachycardia at T3, T4 and T5 were higher in groupⅠ andII than in groupⅢ andⅣ (P<0.05). Conclusion Sufentanil 1.0μg/kg has least stress response during anesthesia induction.