与瑞芬太尼相比，舒芬太尼诱导麻醉可改善血流动力学稳定性和脑组织氧合：一项随机对照试验。
Improved haemodynamic stability and cerebral tissue oxygenation after induction of anaesthesia with sufentanil compared to remifentanil: a randomised controlled trial.
机构信息
Department of Anaesthesiology, University Medical Center Groningen, Hanzeplein 1, PO Box 30 001, 9700, RB, Groningen, The Netherlands.
Department of Anaesthesiology, AZ Maria Middelares Gent Buitenring Sint-Denijs 30, 9000, Ghent, Belgium.
出版信息
BMC Anesthesiol. 2020 Oct 7;20(1):258. doi: 10.1186/s12871-020-01174-9.
BACKGROUND
Balanced anaesthesia with propofol and remifentanil, compared to sufentanil, often decreases mean arterial pressure (MAP), heart rate (HR) and cardiac index (CI), raising concerns on tissue-oxygenation. This distinct haemodynamic suppression might be attenuated by atropine. This double blinded RCT, investigates if induction with propofol-sufentanil results in higher CI and tissue-oxygenation than with propofol-remifentanil and if atropine has more pronounced beneficial effects on CI and tissue-oxygenation in a remifentanil-based anaesthesia.
METHODS
In seventy patients scheduled for coronary bypass grafting (CABG), anaesthesia was induced and maintained with propofol target controlled infusion (TCI) with a target effect-site concentration (Cet) of 2.0 μg ml and either sufentanil (TCI Cet 0.48 ng ml) or remifentanil (TCI Cet 8 ng ml). If HR dropped below 60 bpm, methylatropine (1 mg) was administered intravenously. Relative changes (∆) in MAP, HR, stroke volume (SV), CI and cerebral (SctO) and peripheral (SptO) tissue-oxygenation during induction of anaesthesia and after atropine administration were analysed.
RESULTS
The sufentanil group compared to the remifentanil group showed significantly less decrease in MAP (∆ = - 23 ± 13 vs. -36 ± 13 mmHg), HR (∆ = - 5 ± 7 vs. -10 ± 10 bpm), SV (∆ = - 23 ± 18 vs. -35 ± 19 ml) and CI (∆ = - 0.8 (- 1.5 to - 0.5) vs. -1.5 (- 2.0 to - 1.1) l min m), while SctO (∆ = 9 ± 5 vs. 6 ± 4%) showed more increase with no difference in ∆SptO (∆ = 8 ± 7 vs. 8 ± 8%). Atropine caused higher ∆HR (13 (9 to 19) vs. 10 ± 6 bpm) and ∆CI (0.4 ± 0.4 vs. 0.2 ± 0.3 l min m) in sufentanil vs. remifentanil-based anaesthesia, with no difference in ∆MAP, ∆SV and ∆SctO and ∆SptO.
CONCLUSION
Induction of anaesthesia with propofol and sufentanil results in improved haemodynamic stability and higher SctO compared to propofol and remifentanil in patients having CABG. Administration of atropine might be useful to counteract or prevent the haemodynamic suppression associated with these opioids.
TRIAL REGISTRATION
Clinicaltrials.gov on June 7, 2013 (trial ID: NCT01871935 ).
背景
与舒芬太尼相比，丙泊酚和瑞芬太尼的平衡麻醉常降低平均动脉压（MAP）、心率（HR）和心指数（CI），这引起了对组织氧合的关注。这种明显的血液动力学抑制作用可能被阿托品减弱。这项双盲 RCT 研究调查了诱导使用丙泊酚-舒芬太尼是否比丙泊酚-瑞芬太尼导致更高的 CI 和组织氧合，如果使用阿托品，在瑞芬太尼为基础的麻醉中，CI 和组织氧合是否会有更显著的有益影响。
方法
在 70 名计划行冠状动脉旁路移植术（CABG）的患者中，使用丙泊酚靶控输注（TCI）诱导和维持麻醉，效应室浓度（Cet）为 2.0μg/ml，舒芬太尼（TCI Cet 0.48ng/ml）或瑞芬太尼（TCI Cet 8ng/ml）。如果 HR 降至 60bpm 以下，静脉给予甲硫酸阿托品（1mg）。分析麻醉诱导期间和阿托品给药后 MAP、HR、每搏量（SV）、CI 以及脑（SctO）和外周（SptO）组织氧合的相对变化（∆）。
结果
与瑞芬太尼组相比，舒芬太尼组的 MAP 下降幅度明显较小（∆=−23±13 对−36±13mmHg），HR 下降幅度（∆=−5±7 对−10±10bpm），SV 下降幅度（∆=−23±18 对−35±19ml）和 CI 下降幅度（∆=−0.8（−1.5 至−0.5）对−1.5（−2.0 至−1.1）l min m），而 SctO 增加幅度（∆=9±5 对 6±4%）更大，SptO 无差异（∆=8±7 对 8±8%）。阿托品引起舒芬太尼组的 HR 增加更高（13（9 至 19）对 10±6bpm）和 CI 增加更高（0.4±0.4 对 0.2±0.3l min m），而舒芬太尼与瑞芬太尼组的 MAP、SV 和 SctO 及 SpO2 无差异。
结论
与丙泊酚和瑞芬太尼相比，丙泊酚和舒芬太尼诱导麻醉可改善血流动力学稳定性，并提高 CABG 患者的 SctO。阿托品的应用可能有助于对抗或预防与这些阿片类药物相关的血液动力学抑制。
试验注册
2013 年 6 月 7 日，Clinicaltrials.gov（试验 ID：NCT01871935）。
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