Videcoq M, Desmonts J M, Depoix-Joseph J P, Malbezin S, Hazebroucq J, Barbier-Böhm G, Flaisler B
Services d'Anesthésie-Réanimation Chirurgicale et de Chirurgie Cardiovasculaire, Hôpital Bichat, Paris.
Ann Fr Anesth Reanim. 1988;7(6):471-8. doi: 10.1016/s0750-7658(88)80085-6.
Because sufentanil has been reported as being able to prevent or treat peroperative hypertensive crises during aorto-coronary artery graft surgery, a study was carried out to compare the haemodynamic effects of sufentanil with those of fentanyl. 20 patients who were to undergo aortocoronary bypass grafting (CABG) were randomly allocated to two equal groups, sufentanil (Sf) and fentanyl (F) groups. A 1 to 5 dose ratio was used so as to have equipotent doses of sufentanil and fentanyl. Induction doses were 10 micrograms.kg-1 sufentanil and 50 micrograms.kg-1 fentanyl. Up to 20 micrograms.kg-1 sufentanil and 100 micrograms.kg-1 fentanyl were then used between intubation and the setting-up of cardiopulmonary bypass (CPB). A bolus of 10 micrograms.kg-1 flunitrazepam was given if necessary, so as to lower the mean arterial pressure (Pa) to below 100 mmHg after intubation, and under 80 mmHg during CPB. Heart rate, Pa, mean pulmonary arterial pressure, pulmonary wedge pressure (Ppw), central venous pressure and cardiac output were measured before anaesthesia, 2 min after intubation, before incision, 2 min after sternotomy, 10 min after the end of CPB, after chest closure, 30 min and 2h after arrival of the patient in the intensive care unit. The only difference found between the two groups was a more rapid drop in left ventricular preload after induction with sufentanil; 2 min after intubation, there was a 26% fall in Ppw with sufentanil (p less than 0.01) and 8% with fentanyl. Before skin incision, this drop was of 32% (p less than 0.01) and 24% (p less than 0.01) respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
由于已有报道称舒芬太尼能够预防或治疗主动脉冠状动脉搭桥手术期间的术中高血压危象，因此开展了一项研究，比较舒芬太尼与芬太尼的血流动力学效应。20例即将接受主动脉冠状动脉搭桥术（CABG）的患者被随机分为两组，即舒芬太尼（Sf）组和芬太尼（F）组。采用1:5的剂量比，以使舒芬太尼和芬太尼的剂量等效。诱导剂量为舒芬太尼10μg·kg⁻¹和芬太尼50μg·kg⁻¹。然后在插管至建立体外循环（CPB）期间，使用高达20μg·kg⁻¹的舒芬太尼和100μg·kg⁻¹的芬太尼。必要时给予10μg·kg⁻¹氟硝西泮推注，以便在插管后将平均动脉压（Pa）降至100 mmHg以下，在CPB期间降至80 mmHg以下。在麻醉前、插管后2分钟、切口前、胸骨切开后2分钟、CPB结束后10分钟、胸部关闭后、患者进入重症监护病房后30分钟和2小时测量心率、Pa、平均肺动脉压、肺楔压（Ppw）、中心静脉压和心输出量。两组之间唯一的差异是舒芬太尼诱导后左心室前负荷下降更快；插管后2分钟，舒芬太尼组Ppw下降26%（p<0.01），芬太尼组下降8%。在皮肤切口前，该下降分别为32%（p<0.01）和24%（p<0.01）。（摘要截断于250字）
