Guggenberger H, Schroeder T H, Vonthein R, Dieterich H-J, Shernan S K, Eltzschig H K
Tübingen University Hospital, Department of Anesthesiology and Intensive Care Medicine, Tübingen, Germany.
Eur J Anaesthesiol. 2006 Oct;23(10):832-40. doi: 10.1017/S0265021506000251. Epub 2006 Mar 2.
High-dose opioid anaesthesia contributes to decreasing metabolic and hormonal stress responses in patients undergoing cardiac surgery. However, the increase in context-sensitive half-life of opioids given as a high-dose regimen can affect postoperative respiratory recovery. In contrast, remifentanil can be given in high doses without prolonging context-sensitive half-life due to its rapid metabolism. Therefore, we performed a prospective, randomized trial to compare anaesthesia consisting of propofol/remifentanil or propofol/sufentanil with regard to postoperative respiratory function and outcome.
Patients undergoing coronary artery bypass grafting were randomized to a propofol/remifentanil (0.5-1.0 microg kg(-1) min(-1)) or propofol/sufentanil (30-40 ng kg(-1) min(-1)) based anaesthetic. Carbon dioxide response, forced expiratory volume in one second, vital capacity, and functional residual capacity were measured 1 day prior to the operation, 1 h before extubation, 1, 24 and 72 h after extubation. In addition, the incidence of atelectasis, pulmonary infiltrates, intensive care unit and postoperative length of stay were compared. Patients and physicians were blinded to the treatment group.
Twenty-five patients in each treatment group completed the study. There was no difference between patients of the treatment groups regarding demographics, risk- or pain scores. In all patients, carbon dioxide response, forced expiratory volume in one second, vital capacity and functional residual capacity were decreased postoperatively compared to baseline. Patients randomized to remifentanil had less depression of carbon dioxide response, less atelectasis and shorter postoperative length of stay (12 d vs. 10 d) than after sufentanil (P < 0.05).
Intraoperative use of high-dose remifentanil for coronary artery bypass grafting may be associated with improved recovery of pulmonary function and shorter postoperative hospital length of stay than sufentanil.
高剂量阿片类药物麻醉有助于降低心脏手术患者的代谢和激素应激反应。然而，高剂量给药方案下阿片类药物的时量相关半衰期延长会影响术后呼吸恢复。相比之下，瑞芬太尼由于代谢迅速，高剂量给药时不会延长时量相关半衰期。因此，我们进行了一项前瞻性随机试验，比较丙泊酚/瑞芬太尼或丙泊酚/舒芬太尼麻醉对术后呼吸功能和结局的影响。
接受冠状动脉搭桥术的患者被随机分为基于丙泊酚/瑞芬太尼（0.5 - 1.0微克·千克⁻¹·分钟⁻¹）或丙泊酚/舒芬太尼（30 - 40纳克·千克⁻¹·分钟⁻¹）的麻醉组。在手术前1天、拔管前1小时、拔管后1、24和72小时测量二氧化碳反应、一秒用力呼气量、肺活量和功能残气量。此外，比较肺不张、肺部浸润、重症监护病房入住率和术后住院时间的发生率。患者和医生对治疗组情况不知情。
每个治疗组各有25例患者完成研究。治疗组患者在人口统计学、风险或疼痛评分方面无差异。与基线相比，所有患者术后的二氧化碳反应、一秒用力呼气量、肺活量和功能残气量均降低。随机接受瑞芬太尼的患者与接受舒芬太尼的患者相比，二氧化碳反应抑制较轻、肺不张较少且术后住院时间较短（12天对10天）（P < 0.05）。
冠状动脉搭桥术中使用高剂量瑞芬太尼可能比舒芬太尼更有助于改善肺功能恢复并缩短术后住院时间。
