Fentanyl and sufentanil increase intracranial pressure in head trauma patients.
Fentanyl and sufentanil increase intracranial pressure in head trauma patients.
复制标题
芬太尼和舒芬太尼会增加头部外伤患者的颅内压。
DOI：
10.1097/00000542-199209000-00002
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发表时间：
1992
期刊：
影响因子：
8.8
通讯作者：
N. Pace
中科院分区：
文献类型：
--
作者：
R. Sperry;P. Bailey;M. Reichman;J. Peterson;P. B. Petersen;N. Pace
尽管阿片类药物经常用于严重脑外伤患者，但此类药物对颅内压的影响仍存在争议。观察9例重型颅脑损伤患者芬太尼和舒芬太尼对颅内压的影响。在所有患者中，在研究之前都进行了颅内压监测。在静脉注射芬太尼(3微克·kg~(-1))或舒芬太尼(0.6微克·kg~(-1))之前，用维库溴铵完全阻断神经肌肉，以掩蔽和随机的方式持续1分钟。24小时后，患者以同样的方式接受另一种阿片类药物治疗。连续记录给药后1h的动脉血压、心率和颅内压。芬太尼的平均颅内压升高8+/-2 mm Hg，舒芬太尼的平均颅内压升高6+/-1 mm Hg。这些增长在统计上是显著的。这两种药物在临床上对平均动脉压(芬太尼，11+/-6毫米汞柱；舒芬太尼，10+/-5毫米汞柱)产生轻微的降低，但在统计学上有显著意义。心率没有明显变化。这些结果表明，中等剂量的强效阿片类药物可以显著增加重型颅脑损伤患者的颅内压。
Although opioids frequently are administered to patients with severe head trauma, the effects of such drugs on intracranial pressure are controversial. Nine patients with severe head trauma were studied for the effects of fentanyl and sufentanil on intracranial pressure (ICP). In all patients, ICP monitoring was instituted before the study. Full neuromuscular blockade was achieved with vecuronium bromide before the administration of either fentanyl (3 micrograms.kg-1) or sufentanil (0.6 microgram.kg-1) as an intravenous bolus over a 1-min period in a masked and random fashion. Patients received the other opioid in the same fashion 24 h later. Arterial blood pressure, heart rate, and ICP were recorded continuously for the 1 h after drug administration. Fentanyl was associated with an average ICP increase of 8 +/- 2 mmHg, and sufentanil with an increase of 6 +/- 1 mmHg. These increases were statistically significant. Both drugs produced clinically mild decreases in mean arterial blood pressure (fentanyl, 11 +/- 6 mmHg; sufentanil, 10 +/- 5 mmHg) that nevertheless were statistically significant. No significant changes in heart rate occurred. These results indicate that modest doses of potent opioids can significantly increase ICP in patients with severe head trauma.