2021 年第 9 期 第 16 卷

两种麻醉模式对二尖瓣置换术患者的镇痛效果比较

Comparison of the analgesic effects on patients undergoing mitral valve replacement between two anesthesia models

作者：盖玉兵盖玉滨楚磊

英文作者：Gai Yubing Gai Yubin Chu Lei

单位：哈尔滨医科大学附属第一医院心外科150000

英文单位：Department of Cardiac Surgery the First Affiliated Hospital of Harbin Medical University Harbin 150000 China

关键词：二尖瓣置换术；麻醉模式；镇痛效果；免疫功能；不良反应

英文关键词：Mitralvalvereplacement;Anesthesiamodel;Analgesiceffect;Immunefunction;Adversereactions

• 摘要：

• 目的 探讨静脉注射芬太尼与靶控输注舒芬太尼对二尖瓣置换术患者的镇痛效果。方法 选取哈尔滨医科大学附属第一医院2016年2月至2018年2月收治的拟行二尖瓣置换术患者96例。应用随机数字表法分为观察组与对照组，各48例。对照组静脉注射芬太尼进行麻醉，观察组靶控输注舒芬太尼进行麻醉。比较2组围术期的心率、平均动脉压，术后睁眼时间以及拔管时间，拔管后不同时点的疼痛视觉模拟量表评分，手术前后血浆白细胞介素6（IL-6）和IL-10水平，以及不良反应发生情况。结果 观察组气管插管即刻、切皮时和体外循环后5、30 min的心率、平均动脉压水平均显著低于对照组，术后睁眼时间以及拔管时间均早于对照组［(1.6±0.8)h比（3.2±0.9）h，(3.5±1.7)h比（8.6±1.9）h］，拔管即刻和拔管后2、8 h的疼痛视觉模拟量表评分均低于对照组,术毕即刻和术后24、48 h的血浆IL-6水平均低于对照组，IL-10水平均高于对照组，高血压、呕吐、咳嗽、躁动发生率均低于对照组（均P＜0.05）。结论 与静脉注射芬太尼比较，靶控输注舒芬太尼应用于二尖瓣置换术患者可发挥理想的麻醉效果，同时有利于减轻患者围术期疼痛，降低应激反应程度，减少不良反应的发生。

• Objective To investigate the analgesic effects of intravenous injection of fentanyl and target controlled infusion of sufentanil on patients undergoing mitral valve replacement. Methods From February 2016 to February 2018, 96 patients undergoing mitral valve replacement in the First Affiliated Hospital of Harbin Medical University were selected. They were randomly divided into observation group and control group, with 48 cases in each group. The control group was given intravenous injection of fentanyl for anesthesia, and the observation group was given target controlled infusion of sufentanil for anesthesia. The perioperative heart rate and mean arterial pressure, postoperative eye opening time and extubation time, pain visual analogue scale (VAS) score at different time points after extubation, plasma interleukin-6(IL-6) and IL-10 levels before and after operation, and the incidence of adverse reactions were compared between the two groups. Results The heart rate and mean arterial pressure level of the observation group immediately after tracheal intubation, during skin incision, 5 min and 30 min after cardiopulmonary bypass were significantly lower than those of the control group, the postoperative eye opening time and extubation time of the observation group were shorter than those of the control group ［(1.6±0.8)h vs (3.2±0.9)h, (3.5±1.7)h vs (8.6±1.9)h］, the pain VAS scores of the observation group immediately after extubation, 2 and 8 h after extubation were lower than those of the control group, the plasma levels of IL-6 of the observation group immediately after operation, 24 and 48 h after operation were lower than those of the control group, IL-10 levels of the observation group at above time points were higher than those of the control group, and the incidences of hypertension, vomiting, cough and agitation of the observation group were lower than those of the control group (all P<0.05). Conclusion Compared with intravenous injection of fentanyl, target controlled infusion of sufentanil in patients with mitral valve replacement can play an ideal anesthetic effect, meanwhile, it is conducive to reduce the perioperative pain, degree of stress reaction and occurrence of adverse reactions.