丙泊酚镇静下瑞芬太尼对不同年龄患者抑制气管插管反应的半数有效浓度

目的 测定丙泊酚镇静深度下瑞芬太尼抑制不同年龄患者插管反应的半数有效血浆靶控浓度(Cp50)、半数有效实测浓度(Cm50)值、半数有效效应室浓度(EC50)值.方法 60例上腹部手术患者,男37例、女23例,年龄22岁～82岁,分为:青年组(n=20),22岁～44岁,中年组(n=20),45岁～64岁,老年组(n=20),65岁～82岁.所有患者靶控输注丙泊酚、调节丙泊酚靶控输注血浆浓度将脑电双频指数(bispectral index,BIS)目标值定为45～55,待BIS目标值稳定5 min,靶控输注瑞芬太尼.瑞芬太尼的血浆靶控浓度按序贯法确定,输注5 min给予维库溴铵0.1 mg/kg行气管插管,记录血流动力学变化和计算瑞芬太尼Cp50、Cm50、EC50值.结果 3组患者瑞芬太尼抑制插管反应的Cp50和95%CI分别是5.77 μg/L.,4.76 μg/L～7.01 μg/L;4.80 μg/L,3.56 μg/L～6.48 μg/L;4.06 μg,/L,3.52 μg,/L～4.92 μg/L.青年组与中年组、老年组差异有统计学意义(P<0.01),中年组与老年组差异有统计学意义(P<0.05).EC50和95%CI分别是5.90μg/L,4.47 μg/L～7.68 μg/L;4.60 μg/L,3.03 μg/L～5.90 μg/L;4.06 μg/L,2.97 μg/L～5.42 μg/L.青年组与中年组、老年组差异有统计学意义(P<0.05),中年组与老年组差异有统计学意义(P<0.01).Cm50和95%CI分别是4.25 μg/L,2.04 μg/L～6.47 μg/L;3.62 μg/L,1.70 μg/L～5.54 μg/L;3.09 μg/L,1.3μ/L～4.89 μg/L.青年组与老年组差异有统计学意义(P<0.01).3组患者在达到目标BIS值时丙泊酚靶控浓度分别为(3.6±0.6)mg/L、(3.4±0.8)mg/L、(2.7±0.8)mg/L,青年组与老年组差异有统计学意义(P<0.05).结论 丙泊酚复合瑞芬太尼用于抑制气管插管反应,在维持BIS值为45～55时,各年龄组之间的丙泊酚靶控输注血浆浓度、瑞芬太尼的Cp50、Cm50、EC50差异有统计学意义.

CE50 of remifentanil to inhibit tracheal intubation stress in different aged patients with propofol sedation

Objective To determine the half effective target-controlled plasma concentration(Cp50),half measured plasma concentration(Cm50)and half eflfective acting-site concentration(EC50)of remifentanil in different aged patients with propofol sedation. Methods Sixty patients were divided into youth group(22yr～44yr),middle aged group(45yr～64yr)and elderly group(65yr～82yr). All patients received a target-controlled infusion(TCI)of propofol to keep plasma concentration at 3 mg/L(target-controlled concentrafton),and to maintain bispectral index(BIS)value between 45 and 55.Remifentanil was administered with TCI,and the concentration of remifentanil was detemlined using an up-and-down sequential allocating method.Vecuronium(0.1 mg/kg)was glven to facilitate tracheal intubation 5 min after remifentanil infusion.Results %50(95%CI)for inhibiting tracheal intubation response in three groups were 5.77 μg/L(4.76 μg/L～7.01 μg/L),4.80 μg/L(3.56 μg/L～μg 6.48 μg/L)and 4.06μg/L(3.52 μg/L～4.92 μg/L),in youth,middle aged and elderly groups,respectively(P<0.01).EC50(95%CI)were 5.90μg/L(4.47～7.68 μg/L),4.(95%CI)were 4.25μg/L(2.04～6.47 μg/L),3.62 μg/L(1.70 μg/L～5.54 μg/L)and 3.09 μg/L(1.3 μg/L～4.89 μg/L)in three groups,respectively(P<0.05,between youth and elderly groups).Plasma concentrations of propofol in three groups were 3.6 ±0.6.3.4±0.8 and 2.7±0.8 mg/L,respectively(P<0.05 between youth and elderly groups).Condusion Cp50,EC50 and Cm50 of remifentanil for inhibiting tracheal intubation response were significantly different in three groups with TCI propofol sedation.