标题：不同剂量芬太尼与舒芬太尼对高血压患者无痛支气管镜麻醉效果

      作者：张洪军 1，李明星 2*
    (1.苏州大学医学院，江苏 苏州 215325；
2.同济大学附属上海市肺科医院麻醉科，上海 200433)

      卷次： 2012年23卷8期

      【摘要】 目的 比较不同剂量芬太尼与舒芬太尼在高血压患者支气管镜检查中对应激反应的抑制效应。
方法 133例行支气管镜检查的高血压患者，随机分为三组：芬太尼 2 μg/kg (F2组，n=44)，芬太尼 4 μg/kg (F4
组，n=43)，舒芬太尼 0.4 μg/kg (S组，n=46)。各组诱导时先分别给予芬太尼 2 μg/kg、芬太尼 4 μg/kg、舒芬太尼
0.4 μg/kg，随后缓慢推注丙泊酚1 mg/kg；意识消失后给予司可林1 mg/kg，肌肉松弛后置入喉罩，镜检开始；术中
丙泊酚25~75 μg/(kg· min)持续泵入维持麻醉。记录诱导前(T1)、诱导后插入喉罩前(T2)、置入喉罩时(T3)、支气管
镜过声门时(T4)、过声门后 2 min (T5)、灌洗刷检和活检或支气管扩张时刻(T6)患者的SBP和HR。记录患者术中
SpO2变化和T3、T4、T6时刻呛咳和体动。结果 与T1比，三组患者SBP在T2时刻均明显下降(P＜0.05)，F2组T3、T4
明显升高(P＜0.05)；与F2组比较，F4和S组SBP在T3、T4明显降低(P＜0.05)。F2组患者在时刻呛咳及体动发生
率明显高于F4和S组(P＜0.05)。结论 芬太尼4 μg/kg及舒芬太尼0.4 μg/kg均能很好的抑制高血压患者在支气
管镜检查中的心血管应激反应。

      【关键词】 芬太尼；舒芬太尼；高血压；支气管镜检查；应激反应

      【中图分类号】 R544.1 【文献标识码】 A 【文章编号】 1003—6350(2012)08—011—03<

br>Effects of different doses of fentanyl and sufentanil on stress response in hypertensive patients during
bronchoscopy.
ZHANG Hong-jun 1, LI Ming-xing 2*. 1. Medical School of Soochow University, Suzhou 215325, Jiangsu,
CHINA; 2. Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai
200433, CHINA

【Abstract】 Objective To compare the inhibitive effects of different doses of fentanyl and sufentanil in hyper-
tensive patients during bronchoscopy on stress response. Methods 133 patients undergoing bronchoscopy with hy-
pertension were randomly assigned int three groups: group F2 (Fentanyl 2 μg/kg, n=44), group F4 (Fentanyl 4 μg/kg,
n=43), group S (Sufentanil 0.4 μg/kg, n=46). Patients in the three groups was firstly injected intravenously with fentan-
yl 2 μg/kg, fentanyl 2 μg/kg, sufentanil 0.4 μg/kg, respectively , followed by 1 mg/kg propofol by I.V slowly, After the
loss of consciousness, 1 mg/kg succinylcholine was infused. Laryngeal mask was not inserted until muscle relaxation.
Then begin the procedure. Propofol were continuously infused at a rate of 25~75 μg· kg-1· min-1 to maintain anesthesia.
SBP, DBP and HR were recorded before induction (T1), after induction and before laryngeal mask insertion (T2), laryn-
geal mask insertion (T3), bronchoscope through glottis (T4), 2 min after bronchoscope through glottis (T5), during la-
vage, biopsy and dilation of bronchus (T6). In the meantime, SpO2, cough and body movement at T3, T4, T6 were also
observed and recorded. Results SBP, DBP at T2 in three groups were decreased significantly (P<0.05), and increased
at T3, T4. F2 group increased more significantly than the other two groups (P<0.05).The cases of cough and body
movement in group F2 was more markedly than the other two groups at T3, T4 (P<0.05), But there was no statistically
significant difference among the three groups at T6 (P>0.05). No significant difference was seen in HR among the
three groups (P>0.05). Moreover, oxygen saturation below 95% has not been observed in all patients during the bron-
choscopy. Conclusion Both fentanyl 4 μg/kg and sufentanil 0.4 μg/kg can inhibit the cardiovascular stress response
of hypertensive patients during bronchoscopy.