靶控输注不同浓度丙泊酚诱导重症肌无力患者气管插管时舒芬太尼的半数有效浓度

目的研究靶控输注（TCI）不同浓度丙泊酚复合气管内表面麻醉,在无肌松药下诱导重症肌无力患者气管插管所需舒芬太尼的半数有效浓度及两药复合的相互作用。方法拟行经胸骨正中劈开胸腺切除术的重症肌无力患者40例,ASA Ⅰ或Ⅱ级（I型6例,Ⅱa型8例,Ⅱb型20例,Ⅲ型2例,Ⅳ型4例）。按丙泊酚血浆靶浓度（Cp）不同分A、B两组,每组20例。A组丙泊酚Cp维持3.5μg/ml不变,B组Cp维持4μg/ml不变;舒芬太尼采用效应室浓度（Ce）靶控输注,按序贯法确定浓度,依次为0.1、0.15、0.23、0.34、0.5ng/ml等比递增,相邻效应室靶浓度之间比例为1.5。复合气管内表面麻醉后行气管插管。监测诱导时、插管过程中的血压、心率和脑电双频指数（BIS）。序贯法进行诱导,即前1例患者若在置入喉镜、喉麻管及插管时无体动呛咳,则下1例患者接受的药物降低1个浓度;若在任何一个环节患者有体动或呛咳,则下1例患者接受的药物提高1个浓度。结果丙泊酚为3.5μg/ml时,50%患者完成插管时舒芬太尼的浓度为0.23ng/ml,95%可信区间为（0.20～0.27）ng/ml。丙泊酚为4μg/ml时,50%患者完成插管时舒芬太尼的浓度为0.22ng/ml,95%可信区间为（0.17～0.28）ng/ml。结论在不使用肌松药并复合气管内表面麻醉的情况下完成气管插管,丙泊酚血浆靶浓度分别为3.5μg/ml和4μg/ml时,舒芬太尼半数有效效应室靶浓度为0.23ng/ml和0.22ng/ml,两药复合有协同作用。

Medium effective concentration of sufentanil required to tracheal intubation response in myasthenia gravis MG)patients anesthetized with different concentration of propofol by target controlled infusion(TCI)

Objective To determine the medium effective concentration （Ce50） of snfentanil based on the Target controlled infusion （TCI） of propofol-sufentanil in the endotrachea surface anesthesia to induce tracheal intubation response in myasthenia gravis （MG） patients anesthetized without muscle relaxant. And to explore the interaction between two anesthetic agents. Methods Forty ASA Ⅰ - Ⅱ MG patients undergoing thymectomy （Ⅰ type 6 people;Ⅱa type 8 people;Ⅱb type 20 people;Ⅲ type 2 people;Ⅳ type 4 people）. Anesthesia was induced with both propofol and sufentanil given by TCI. The target plasma concentration （Cp） of propofol was set at 3.5 μg/ml and 4 μg/ml throughout induction, and the target effect concentration（Ce）of sutentanil was set at 0.10ng/ml,0.15 ng/ml,0.23 ng/ml,0.34 ng/ml and 0.5 ng/ml. The Ce50 was determined by up and down sequential trial. The ratio of two consecutive target concentration was 1.5. Intubation was performed under the combined topical anesthesia of endotrachea.BP, HR and bispeetral index （BIS） were monitored during induction and intubation. In the induction of up and down sequential trial. If cough and movement did not occur when laryngoscope, larynx anesthetic tube and intubation were inserted,the next patient received lower concentration; if not, the next patient received higher concentration. Results The Ce50 of snfentanil for intubation was 0.23 ng/ml with propofol at target plasma concentration of 3.5 μg/ml. The 95% confidence interval was （0.20-0.27）ng/ml. The Ce50 of sufentanil for intubation was 0.22 ng/ml with propofol at target plasma concentration of 4 μg/ml. The 95% confidence interval was （0.17-0.28）ng/ml. Conclusions Without muscle relaxant, when the induction of anesthesia with TCI of propofol is at target effect concentration of 3.5 μg/ml or 4 μg/ml ,the Ce50 of sufentanil is 0.23 ng/ml and 0.22 ng/ml respectively in the combined topical anesthesia of endotrachea during intubations. Combined infusion of propofoland sufenta