比较不同浓度舒芬太尼效应室靶控输注在老年冠心病人中的应用比较不同浓度舒芬太尼效应室靶控输注在老年冠心病人中的应用袁治国袁治国 吕黄伟吕黄伟 王俊科王俊科中国医科大学附属第一医院麻醉科中国医科大学附属第一医院麻醉科 沈阳，沈阳，110001110001摘要摘要目的目的 比较在老年冠心病人全麻诱导及气管插管过程中应用不同浓度舒芬太尼效应室靶控输注对血流动力学的影响。方法方法 选取择期行CABG 的病人 60 例，ASA 分级 II级。按舒芬太尼效应室靶浓度（Ce）不同将病人随机分为：L 组（0.5ng/ml） ；M 组（0.6ng/ml）和 H 组（0.7ng/ml） 。每组各 20 例。分别在麻醉诱导前（T1） 、诱导后(T2)、气管插管后 1min(T3)、3min(T4)记录HR、SBP、DBP、CO、CI、SI、SVR。结果结果 L 组 BP 和 HR 在 T3 和T4 时较 T1 时均明显增高，而 H 组在 T2 时 BP 和 HR 明显降低（P0.05）.ConclusionConclusion This study suggests that target controlled infusion of sufentanil at effect-site concentration (Ce0.6ng/ml) may be safely applied in elderly patients with coronary heart disease during induction and intubation, which is maybe more beneficial to maintaining the hemodynamic stability【KeyKey WordsWords】: sufentanil, effect site concentration, cardiovascular homeostasis, elderly patients, coronary heart disease The peri-intubation period is one of the high stress moments of general anesthesia. Induction and endotracheal intubation may induce clinically relevant cardiovascular response, especially in elderly patients suffering from coronary heart disease, whose compensation capability for hemodynamics was limited and compromised due to the existed pathological changes of coronary artery. Various pharmacological strategies have been proposed to maintain hemodynamic stability in response to intubaiton. Opioids, such as fentanyl, remifentanil and sufentanil, etc, are widely applied to control the cardiovascular response during peri-intubation period. More data have shown that a linear relationship exists between the increasing dose of opioids applied and reduction of intubation response in cardiovascular system1,2.Sufentanil is an highly selective -opioid receptor agonist that provides intense analgesia with its unique pharmakokinetic and pharmacodynamic profile and has been shown to be effective in preventing sympathetic response and maintaining the cardiovascular system stability in cardiac surgery. Moreover, the use of a target-controlled infusion at effect site concentration showed to be more effective in maintaining cardiovascular stability as compared with traditional weight-adjusted infusion. Therefore we conducted a randomized, double blind study to compare the effectiveness and safety of sufentanil at different effect site concentrations in maintaining cardiovascular homeostasis during peri-intubation period in elderly patients with coronary heart diseaseMaterials and methodsSixty patients, ASA physical status II, aged 72.26.5 years(mean SD) and weighting 64.711.3kg(mean SD), scheduled for elective CABG were prospectively enrolled in the study.Patients fasted for 8h before surgery and received scopolamine (0.3mg,im) and morphine (10mg,im) 30 min before entering operation room. After arrival in the operating theater one 18-gauge intravenous cannulas were placed on the forearm, and 10 ml/kg Ringers lactate solution was infused. Standard monitoring was used throughout the study, including noninvasive arterial blood pressure, electrocardiography, heart rate(lead II and V), and pulse oximetry. In all patients the BIS was also monitored using an EEG monitor ( BIS XP for monitor A2000; Aspect medical systems Inc., Natick, MA, USA). Invasive arterial blood pressure ( left radial artery) and central venous pressure (right jugular vein) monitoring were also introduced under local anesthesia. Noninvasive Impedance Cardiography monitoring (Bioz, the ICG Cardiodynamics，USA), recoding CO,CI,SI and SVR, were also used before induction. All patients were induced with Midazolam (0.05mg/kg, IV), Vecuronium (0.1mg/kg,IV),Etomidate (0.2mg/kg), and a target-controlled infusion of sufentanil (Bovill model, Fresenuius Vial system, infusion technology, Rchestra, USA ) at different effect site concentration (Ce). All the patients were randomly divided in each of three groups according to the effect site concentration: L group(Ce=0.5ng/ml)；M group (Ce=0.6ng/ml) and H group (Ce=0.7ng/ml) (n=20 each). Endotracheal intubation was performed when each patient BIS maintained stable ranging between 40-50 and then ventilation was assisted with a oxygen-isoflurane mixture and mechanically controlled using a Cato-Drager anesthesia working station set to maintain an end tidal partial pressure of carbon dioxide randing between 35-40 mmHg and facilitated by vecuronium as muscle relaxant.Heart rate, systolic and diastolic arterial blood pressure (SBP,DBP), and non-invasive cardiovascular hemodynamic variables (including CO, CI, SI and SVR), were all recorded simultaneously at different interval time during peri-intubation period: baseline (T1) ,after induction (T2), 1min(T3), 3min(T4)after intubation.Statistical analysisStatistical analysis was performed using SPSS10.0 (SPSS Inc. USA). Changes in HR, BP and hemodynamic variables were analyzed using analysis of variance and t-test. A value of P less or equal to 5% was considered statistically significant. Data are pres