| Background and objective: The stress response during open-heart surgery under cardiopulmonary bypass affects the safety and recovery of the patients scheduled for open-heart surgery. To lessen the intensity of stress response benefits to cut down the incidence rate of postoperative complications and promote the postoperative rehabilitation of the patients. With low-grade cardiac function and not fine tolerance for surgery, the patients would take large size risk for open-heart surgery. At the same time, the series of severe stimulus during anesthesia and operation period, such as endotracheal intubation, skin incision, split sternum, free great vessels, extracorporeal circulation, et al, would lead to serious stress response. As a result, these serious stress responses would lead to the disorder of hemodynamics and immunological functions, and directly respect to the postoperative rehabilitation of the patients. Whereas, it is an important research subject how to adjust the appropriate intensity of stress response for hemodynamics stability, important organ perfusion, and nomal immunological function in order to make the patients safety and fine recovery during the ansthesia and surgery period.Stress response refers to the General Adaption Syndrome when body received the various kinds of stimulus from either inside or outside bodies. Besides the direct effects caused by original stimulus, it also shows up neuroendocrine reaction thathosted by sympathico-adrenal system and hypothalamic pituitary adrenal axis(HPA), and changes of some proteins from cell and body fluid and a series of functions and metabolisms.Traditional anesthetic methods for cardiac surgery depended on high dose fentanyl to maintain the the anesthetic degree and to inhibite the severe stress responses, high dose fentanytanesthesia was seemed as weigh as anesthetic methods of cardiac anesthesia. But the present studies show that the high dose fentanyl anesthesia could lead to a series of side effects, such as central ragal bradycardia, musle rigidity, awake delayed, and postoperative long time respiratory depression, and so on. The long tune IPPV under intubition would prolong the time that patients stayed in the intensive care unit and make the stress response heavy in return. Fentanyl anesthesia have a peak effect, and it was reported that fentanyl could not compeletely inhibite the stress response at 100|ag籯g~l. In a word, the high dose anesthetic method is no longer the idealism anesthetic method for cardiac surgery.With the development of cardiac surgery, fast tracking cardiac ansthesia and the low-dose fentanyl anesthesia could achieve clinical effects of hemodynamics and neuroendocrine as similar as the high-dose fentanyl* anesthesia. The usage of new ultra-shortness effect u -opioids, such as remifentanil, shows up well hemodynamics stability effects with seldom catecholamine releasing and memory in the open-heart surgery, the patients could be extubation in short time. But the effectiveness and safety of the low-dose fentanyl or remifentanil anesthesia in open-heart surgery was still few and remained to be further studies.By investigating into the effect of low-dose fentanyl and remifentanil anesthesia on SBP, DBF, HR of hemodynamic, and NA, Ad, COR and IL-6 in plasma surround open-heart surgery, This study is to aim directly at some qestion of low-dose fentanyl and remifentanil anesthesia surround open-heart surgery upon the stress response and explore its effectiveness and safety, so as to provide theoretical base for clinical FTCA for open-heart suegery.Methods:Thirty ASA I - II patients (arterial septal defect or ventricular septal defect) undergoing open-heart surgery were randomized to receive high-dose fentanyl anesthesia (HF, n=10), low-dose fentanyl anesthesia (LF, n=10) or remifentanil anesthesia (RF, n=10). In HF groups, anesthesia was induced with fentanyl 20ug玨g~l, midazolam 0.05mg kg-1, propofol 1.0 mg'kg"1, vecuronium 0.1 mg'kg"1. then, the patients were trachealed intubation and mechanically ventilated wi...
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