Boulton A J, Wilson N, Turnbull K W, Yip R W
Can Anaesth Soc J. 1986 Jul;33(4):475-83. doi: 10.1007/BF03010974.
This study compared the haemodynamic and arginine vasopressin responses of patients to fentanyl or sufentanil anaesthesia for coronary artery bypass surgery. Fourteen normotensive patients with normal left ventricular function were studied. Patients were induced with fentanyl (N = 7) 37.5 micrograms X kg-1 or sufentanil (N = 7) 7.5 micrograms X kg-1 by intravenous infusion over three minutes. Clinically important chest wall rigidity, bradycardia and recall of intraoperative events did not occur. All of the fentanyl patients became hypertensive after induction and five required vasodilator therapy since they did not respond to boluses of fentanyl (12.5 micrograms X kg-1). Two of these five patients had S-T depression greater than 1 mm. Five patients in the sufentanil group became hypertensive after induction. Four of these patients responded to additional sufentanil (3.75 micrograms X kg-1) while one required vasodilator therapy for concomitant S-T depression. Sufentanil attenuated the increase of arginine vasopressin during cardiopulmonary bypass. Levels of arginine vasopressin in the fentanyl group were significantly higher than those of the sufentanil group during bypass. Levels of AVP after bypass were higher in the sufentanil group. The incidence of hypertension was similar in both groups. The hypertension was more easily treated with sufentanil but concomitant vasodilators (nitroglycerine) were required in both patient groups. Neither fentanyl in doses up to 128 +/- 8.7 micrograms X kg-1 nor sufentanil in doses up to 23 +/- 1.4 micrograms X kg-1 can be used as sole agents for anaesthesia in adult coronary artery bypass patients with good ventricular function when induction times are three minutes and bolus top-up doses are used.
本研究比较了接受冠状动脉搭桥手术的患者在芬太尼或舒芬太尼麻醉下的血流动力学和精氨酸加压素反应。研究了14例左心室功能正常的血压正常患者。患者通过静脉输注在三分钟内分别给予芬太尼（N = 7）37.5微克/千克或舒芬太尼（N = 7）7.5微克/千克进行诱导。未出现具有临床意义的胸壁强直、心动过缓和术中事件回忆。所有芬太尼组患者诱导后均出现高血压，其中5例因对芬太尼推注（12.5微克/千克）无反应而需要血管扩张剂治疗。这5例患者中有2例S-T段压低超过1毫米。舒芬太尼组有5例患者诱导后出现高血压。其中4例患者对额外的舒芬太尼（3.75微克/千克）有反应，而1例因伴有S-T段压低需要血管扩张剂治疗。舒芬太尼减轻了体外循环期间精氨酸加压素的升高。在体外循环期间，芬太尼组的精氨酸加压素水平显著高于舒芬太尼组。体外循环后舒芬太尼组的血管加压素水平较高。两组高血压的发生率相似。舒芬太尼更容易治疗高血压，但两组患者均需要使用血管扩张剂（硝酸甘油）。当诱导时间为三分钟并使用推注补充剂量时，对于心室功能良好的成人冠状动脉搭桥患者，剂量高达128±8.7微克/千克的芬太尼和剂量高达23±1.4微克/千克的舒芬太尼均不能用作单一麻醉剂。
