摘要
目的 测定异丙酚麻醉期间瑞芬太尼抑制病人气管插管和切皮时心血管反应的效应室靶浓度（EC50和EC95）。方法 择期全麻手术病人60例，ASAⅠ或Ⅱ级，年龄20～65岁，体重40．75kg，随机分为6组（n=10）：瑞芬太尼靶控输注（TCI），血浆靶浓度分别为1、2、3、4、5、6ng/ml；异丙酚TCI，效应室靶浓度均为4．0μg/ml。病人意识消失后静脉注射维库溴铵0．15mg／kg，气管插管。插管后2min暂停瑞芬太尼TCI，切皮前10min再以诱导时相同浓度瑞芬太尼TCI。记录入室安静时（基础值）、诱导后最低、插管后2min内最高、切皮前1min、切皮后2min内最高的平均动脉压（MAP）和心率（HR）。MAP和HR诱导后最低值与插管后2min内最高值、切皮前1min与切皮后2min内最高值比较升高〉15％为心血管阳性反应。采用Probit法计算瑞芬太尼EC50和EC45。结果 瑞芬太尼抑制气管插管时心血管反应的EC50为4．41ng／ml，95％可信区间（95％CI）为3．97～5．05ng／ml；相应的EC95为6．42ng/ml，95％CI为5．54—8．09ng/ml。瑞芬太尼抑制切皮时心血管反应的Ec50为2．05ng／ml，95％CI为1．36～2．59ng／ml；相应的E艮为3．89ng／ml，95％CI为3．20～5．71ng／ml。结论 异丙酚效应室靶浓度为4．0μg/ml时。靶控输注瑞芬太尼抑制病人对气管插管和切皮诱发的心血管反应呈剂量依赖性，其效应室EC50分别为4．41ng／ml和2．05ng/ml。
Objective To determine the effect-site concentration of remifentanil blunting sympathetic responses to tracheal intubation and skin incision during propofol anesthesia . Methods Sixty ASA Ⅰor Ⅱ patients aged 20-65 yrs weighing 40-75 kg undergoing elective surgery under general anesthesia were enrolled in this study. The patients were premedicated with intramuscular atropine 0.5 mg. ECG, invasive BP, HR, and SpO2 were monitored before and during anesthesia. The patients were randomized to receive remifentanil by TCI at target plasma concentrations of 1, 2, 3, 4, 5 and 6 ng·ml^-1 （n = 10 each）. It takes 5-6 min to achieve the balance between the plasma and effect-site concentration. TCI of propofol was started at target plasma concentration of 4.0 ng·ml^-1 at 6 min after the pre-determined target plasma remifentanil concentration was reached. As soon as the patients failed to respond to verbal command and eyelash reflex was lost tracheal intubation was facilitated with vecuronium 0.15 mg· kg^-1 . The patients were mechanically ventilated （VT=10 ml·kg-1 , RR = 12 bpm）. TCI of remifentanil was suspended at 2 min after intubation and restarted at 10 min before skin incision at the same target plasma concentration before intubation. Intubation response was defined as increase in MAP and HR by 〉 15% of the lowest values after induction within 2 min after intubation; while skin incision response was defined as increase in MAP and HR by 〉 15% of the values at 1 min before incision within 2 min after incision. The target concentration of remifentanil at which the sympathetic responses to intubation and skin incision were blunted in 50% or 95% of the patients （EC50 or EC95 ） was determined by Probit method. Results The mean EC50 of remifentanil was 4.41ng·ml^-1 （95% confidence interval 3.97-5.05 ng·ml^-1 ） and EC95 6.42ng·ml^-1（95% CI 5.54-8.09 ng·ml^-1 ） for tracheal intubation. The mean EC50 of remifentanil was 2.05 ng·ml^-1 （ 1.36-2.59 ng·ml^-1 ） and EC50 3.89ng·ml^-1（3.20-5.71ng·ml^-1 ） for skin incision. Conclusion This study shows that effectsite concentrations of remifentanil of 4.41ng·ml^-1 and 2.05 ng·ml^-1 are effective in blunting sympathetic responses to tracheal intubation and skin incision in 50% of patients respectively during propofol anesthesia.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2007年第1期28-31,共4页
Chinese Journal of Anesthesiology
基金
海南省卫生厅基金资助项目（琼卫2005·78）
关键词
哌啶类
二异丙酚
麻醉
静脉
药物释放系统
剂量效应关系
药物
Piperidines
Propofol
Anesthesia, intravenous
Drug delivery systems
Dose-response relationship, drug
