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目的比较舒芬太尼和芬太尼用于小儿先天性心脏病室间隔缺损(VSD)行室间隔修补术的麻醉效果及安全性。方法选择60例VSD拟行室间隔修补术的患儿,随机分为舒芬太尼组(S组)和芬太尼组(F组),每组30例,在麻醉诱导、切皮前、体外循环(CPB)前各时间点,S组分别静脉注射舒芬太尼1μg/kg;F组分别静脉注射芬太尼10μg/kg。两组均根据循环波动情况增加舒芬太尼和芬太尼的用量,其余麻醉用药相同。分别于患儿入室后(基础值,T0)、诱导时(T1)、插管时(T2)、插管后5 min(T3)、切皮时(T4)、锯胸骨时(T5)、关胸时(T6)测定并记录平均动脉压(MAP)、脉搏(HR)、脉搏血氧饱和度(SpO2)。记录停用麻醉药到拔除气管导管的时间以及不良反应的发生情况。结果两组患儿术前一般情况、CPB时间及手术时间差异无统计学意义。阿片类药物的用量F组约为S组的6倍。S组在T1、T2时HR均很稳定,MAP虽略有下降但差异无统计学意义。S组在T5及T6时HR、MAP均有升高(P<0.05)。F组T1时HR、MAP均有明显下降,其中HR与T0时比较差异有统计学意义(P<0.05);T4、T5时HR、MAP均有明显上升,其中T4时HR、T5时MAP与T0时比较差异有统计学意义(P<0.05)。S组清醒时间和拔管时间均明显短于F组(P<0.05)。两组患儿在诱导时均观察到呛咳发生,S组未观察到肌僵,两组患儿不良反应差异无统计学意义。结论舒芬太尼配合应用咪唑安定、丙泊酚和异氟烷用于小儿先天性心脏病VSD修补术的麻醉是可行的。
Objective To compare the anesthetic efficacy and safety of sufentanil and fentanyl for ventricular septal repair in children with congenital heart disease (VSD). Methods Sixty children with VSD who underwent interventricular septum repair were randomly divided into sufentanil group (group S) and fentanyl group (group F), with 30 cases in each group. Before induction of anesthesia and skin incision, At each time point before cardiopulmonary bypass (CPB), sufentanil (1μg / kg) was intravenously injected into group S, and fentanyl (10μg / kg) was injected into group F respectively. Both groups increased the dosage of sufentanil and fentanyl according to the circulation fluctuation, and the rest of the anesthetic drugs were the same. (T0), induction (T1), intubation (T2), 5 min after intubation (T3), incision (T4), sternum (T5) At chest time (T6), mean arterial pressure (MAP), pulse rate (HR) and pulse oximetry (SpO2) were measured and recorded. Record the time until the anesthetic was withdrawn and the endotracheal tube was removed and the incidence of adverse reactions. Results There was no significant difference in preoperative general condition, CPB time and operation time between the two groups. The amount of opioids in group F was about 6 times that of group S. The HR of S group was stable at T1 and T2, MAP was slightly decreased but the difference was not statistically significant. The HR and MAP of S group increased at T5 and T6 (P <0.05). The HR and MAP of group F decreased significantly at T1 (P <0.05), HR and MAP at T4 and T5 increased significantly T0, the difference was statistically significant (P <0.05). S group awake time and extubation time were significantly shorter than the F group (P <0.05). Two groups of children were observed when induced choking cough, S group was not observed muscle stiffness, two groups of children with no significant difference in adverse reactions. Conclusion Sufentanil combined with midazolam, propofol and isoflurane for pediatric congenital heart disease VSD repair anesthesia is feasible.