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在接受手术的早产婴儿中进行芬太尼麻醉的随机试验:对应激反应的影响
K J Anand1, W G Sippell, A Aynsley-Green
1Department of Paediatrics, John Radcliffe Hospital, Oxford.
Lancet (London, England)
|October 9, 2010
概括
芬太尼在经过专利通道动脉结合的早产婴儿的麻醉显著减少了手术应激反应和术后并发症. 这表明芬太尼可以通过减轻对手术的应激反应来改善结果.
科学领域:
- 新生儿手术 新生儿手术
- 儿科麻醉学 儿科麻醉学
- 进行心血管外科手术.
背景情况:
- 专利动脉管 (PDA) 绑定是早产婴儿的常见手术程序.
- 手术压力可以引起新生儿显著的荷尔蒙和代谢反应.
- 麻醉剂对这些应激反应的影响需要进一步调查.
研究的目的:
- 为了研究芬太尼对早产婴儿PDA结合的荷尔蒙和代谢应激反应的影响.
- 评估芬太尼和术后并发症之间的关联.
主要方法:
- 一项随机对照试验,涉及经过PDA结合的早产婴儿.
- 用氧化和d-tubocurarine,有或没有芬太尼 (10μg/kg IV) 的麻醉方案的比较.
- 测量血激素水平 (上腺素,上腺素,葡萄糖,阿尔多,皮质,11-脱氧皮质,11-脱氧皮质醇),胰岛素/葡萄糖的摩尔比率,血糖,乳酸和酸盐度.
- 评估尿液中的3-甲基希斯提丁/肌素比率和术后并发症.
主要成果:
- 与芬太尼组相比,非芬太尼组的荷尔蒙反应和代谢障碍 (葡萄糖,乳酸,酸盐的增加) 在非芬太尼组显著增加.
- 在非芬太尼群中,在术后的第二天和第三天,尿液中的3-甲基希斯提丁/肌素比较高.
- 在非芬太尼尔组中,循环和代谢并发症的发病率增加.
结论:
- 过早出生的婴儿在氧化和curare麻醉下进行手术时表现出相当大的应激反应.
- 芬太尼麻醉可以减轻这种应激反应.
- 用芬太尼预防手术应激反应可能与经过PDA结合的早产婴儿的手术后结果改善有关.
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