不同效应室靶浓度瑞芬太尼对患者意识消失和伤害性刺激诱发体动反应消失时依托咪酯半数有效浓度的影响

Objective To investigate the effect of different target effect-site concentrations (Ces) ofremifentanil on the median effective concentration (EC50 ) of etomidate required for loss of consciousness and disappearance of nociceptive stimuli-induced body movement. Methods Eighty ASA Ⅰ orⅡ patients aged 18-64 yr scheduled for elective gynecological surgery under general anesthesia were randomly divided into 4 groups ( n = 20 each): group R0 received no remifentanil and R1-3 groups received remifentanil at 3 predetermined target Ces of 1,2 and 3 ng/ml respectively. At the beginning of anesthesia induction, remifentanil was given by target-controlled infusion (TCI) until the predetermined Ces were achieved, TCI of etomidate was then started at a target plasma concentration of 0.6 μg/ml and then the target plasma concentration of etomidate increased by 0.1 μg/ml every 1 min until the patients lost consciousness and the body movement induced by the nociceptive stimuli disappeared. The Ce of etomidate required for loss of consciousness and disappearance of nociceptive stimuli-induced body move-ment was recorded and the EC50 was calculated by Probit method. Results With the increase in the target Ces of remifentanil, the EC50 of etomidate required for loss of consciousness and disappearance of nociceptive stimuli-induced body movement decreased gradually (P < 0.05) .Conclusion Remifentanil given by TCI can enhance the sedative and analgesic effect of etomidate concentration-dependently.     

不同效应室靶浓度瑞芬太尼对患者意识消失和伤害性刺激诱发体动反应消失时依托咪酯半数有效浓度的影响

Objective To investigate the effect of different target effect-site concentrations (Ces) ofremifentanil on the median effective concentration (EC50 ) of etomidate required for loss of consciousness and disappearance of nociceptive stimuli-induced body movement. Methods Eighty ASA Ⅰ orⅡ patients aged 18-64 yr scheduled for elective gynecological surgery under general anesthesia were randomly divided into 4 groups ( n = 20 each): group R0 received no remifentanil and R1-3 groups received remifentanil at 3 predetermined target Ces of 1,2 and 3 ng/ml respectively. At the beginning of anesthesia induction, remifentanil was given by target-controlled infusion (TCI) until the predetermined Ces were achieved, TCI of etomidate was then started at a target plasma concentration of 0.6 μg/ml and then the target plasma concentration of etomidate increased by 0.1 μg/ml every 1 min until the patients lost consciousness and the body movement induced by the nociceptive stimuli disappeared. The Ce of etomidate required for loss of consciousness and disappearance of nociceptive stimuli-induced body move-ment was recorded and the EC50 was calculated by Probit method. Results With the increase in the target Ces of remifentanil, the EC50 of etomidate required for loss of consciousness and disappearance of nociceptive stimuli-induced body movement decreased gradually (P < 0.05) .Conclusion Remifentanil given by TCI can enhance the sedative and analgesic effect of etomidate concentration-dependently.     

新辅助化疗对乳腺癌患者靶控输注异丙酚意识消失时半数有效效应室靶浓度的影响

Objective To investigate the effect of neoadjuvant chemotherapy on EC50 of propofol given by TCI which produces loss of consciousness (LOC) in breast cancer patients.Methods Ninety ASA Ⅰ or Ⅱ breast cancer patients aged 30-60 yr scheduled for elective surgery were allocated into 3 groups according to the chemotherapy the patients received (n=30 each):group Ⅰ control (group C) received no chemotherapy;group Ⅱ taxol and group Ⅲ adriamycine+cyclophosphamide+5-Fu.The patients were unpremedicated.The EC50 of propofol given by TCI was determined by up-and-down technique.The initial effect-site concentration (Ce) of propofol was 2.07μg/ml and the ratio between the 2 successive Ce was 1.09.Loss of response to verbal command and eyelash stimulation was used as sighs of LOC.The EC50 of propofol was calculated.Results The EC50 of propofol causing LOC was significantly lower in group Ⅱ and Ⅲ than in control group.There was no significant difference in the EC50 of propofol which produces LOC between group Ⅱ and Ⅲ.Conclusion The EC50 of propofol causing LOC in breast cancerpatients is decreased by adjuvant chemotherapy.     

新辅助化疗对乳腺癌患者靶控输注异丙酚意识消失时半数有效效应室靶浓度的影响

Objective To investigate the effect of neoadjuvant chemotherapy on EC50 of propofol given by TCI which produces loss of consciousness (LOC) in breast cancer patients.Methods Ninety ASA Ⅰ or Ⅱ breast cancer patients aged 30-60 yr scheduled for elective surgery were allocated into 3 groups according to the chemotherapy the patients received (n=30 each):group Ⅰ control (group C) received no chemotherapy;group Ⅱ taxol and group Ⅲ adriamycine+cyclophosphamide+5-Fu.The patients were unpremedicated.The EC50 of propofol given by TCI was determined by up-and-down technique.The initial effect-site concentration (Ce) of propofol was 2.07μg/ml and the ratio between the 2 successive Ce was 1.09.Loss of response to verbal command and eyelash stimulation was used as sighs of LOC.The EC50 of propofol was calculated.Results The EC50 of propofol causing LOC was significantly lower in group Ⅱ and Ⅲ than in control group.There was no significant difference in the EC50 of propofol which produces LOC between group Ⅱ and Ⅲ.Conclusion The EC50 of propofol causing LOC in breast cancerpatients is decreased by adjuvant chemotherapy.     

舒芬太尼复合TCI异丙酚抑制前列腺电切术老年患者尿道镜置入反应的半数有效效应室靶浓度

目的 确定舒芬太尼复合TCI异丙酚抑制经尿道前列腺电切术(TURP)老年患者尿道镜置入反应的半数有效效应室靶浓度(EC50).方法 拟行TURP的患者22例,年龄65～79岁,体重47～81 kg,ASA分级Ⅰ～Ⅲ级.TCI异丙酚,血浆靶浓度4 μg/ml,异丙酚达到靶浓度后开始TCI舒芬太尼;采用序贯法,按照患者是否发生尿道镜置入反应确定舒芬太尼的效应室靶浓度,初始效应室靶浓度为0.3 ng/ml,相邻浓度比值为1.1.计算舒芬太尼的EC50及其95%可信区间.结果 舒芬太尼抑制尿道镜置入反应的EC50为0.23 ng/ml,95%可信区间为0.12～0.44 ng/ml.结论 复合TCI异丙酚(血浆靶浓度4 μg/ml)时,舒芬太尼抑制TURP老年患者尿道镜置入反应的EC50为0.23 ng/ml.

Abstract：

Objective To determine the half-effective target effect-site concentration (EC50 ) of sufentanil inhibiting the urethroscope insertion response when combined with propofol by target-controlled infusion (TCI) in the elderly patients undergoing transurethral resection of prostate (TURP) . Methods Twenty-two ASA Ⅰ- Ⅲ patients, aged 65 -79 yr, weighing 47-81 kg, undergoing TURP, were enrolled in the study. Anesthesia was performed with TCI of propofol and sufentanil. The target plasma concentration of propofol was 4 μg/ml. The target effect-site concentration of sufentanil was determined by up-and-down sequential trial. The initial target effect-site concentration of sufentanil was 0.3 ng/ml and the ratio of the target concentrations between the two consecutive patients was 1.1. The ECW and 95% confidence interval of sufentanil required to inhibit the response to urethroscope insertion were calculated. Results The EC50 of sufentanil required to inhibit the urethroscope insertion response was 0.23 ng/ml (95% confidence interval 0.12-0.44 ng/ml). Conclusion When combined with propofol by TCI (target plasma concentration 4 μg/ml), the EC50 of sufentanil inhibiting the response to urethroscope insertion is 0,23 ng/ml in the elderly patients undergoing TURP.     

卵巢周期对患者异丙酚镇静效应的影响

目的 评价卵巢周期对患者异丙酚镇静效应的影响.方法 择期拟行妇科腹腔镜手术患者加例,ASA分级Ⅰ或Ⅱ级,年龄20.加岁,体重指数20～25 kg/m2,根据孕酮水平分为卵泡期组(F组,血清孕酮浓度0.31～1.52 ng/ml)和黄体期组(L组,血清孕酮浓度5.16～18.56 ng/ml),每组20例.麻醉诱导时靶控输注异丙酚,初始血浆靶浓度2 μg/ml,达到预期血浆靶浓度后每隔30 s递增0.5μg/ml直至患者意识消失及BIS值降至50.记录患者意识消失时的BIS值、异丙酚血浆靶浓度,记录BIS值降至50时的异丙酚血浆靶浓度.结果 与L组比较,F组意识消失时和BIS值降至50时的异丙酚血浆靶浓度升高(P＜0.05或0.01),意识消失时的BIS值差异无统计学意义(P＞0.05).结论 卵巢周期可影响异丙酚的镇静效应,表现为卵泡期的镇静效应低于黄体期.

Abstract：

Objective To investigate the effect of ovarian cycle on the sedative effect of propofol in patients. Methods Forty ASA Ⅰ or Ⅱ patients, aged 20-40 yr, with body mass index 20-25 kg/m2 , scheduled for elective gynecologic laparoscopic surgery, were divided into 2 groups according to the progesterone level ( n = 20 each): follicular phase group (group F, serum progesterone concentration 0.31-1.52 ng/ml) and luteal phase group (group L, serum progesterone concentration 5.16-18.56 ng/ml). Anesthesia was induced with target-controlled infusion (TCI) of propofol and iv injection of fentanyl and cisatracurium. The initial target plasma concentration (Cp) of propofol was set at 2 μg/ml, after the Cp reached the predetermined level, the Cp increased by 0.5 μg/ml every 30 s until the patients lost consciousness and BIS value was decreased to 50. The BIS value and Cp of propofol was recorded when the patients lost consciousness. The Cp of propofol was also recorded when BIS value was decreased to 50. The patients were tracheal intubated and mechanically ventilated. Anesthesia was maintained with TCI of propofol combined with remifentanil. BIS value was maintained at 45-55 by adjusting the Cp of propofol. Results The Cps of propofol were significantly higher when the patients lost consciousness and when BIS value was decreased to 50 in group F than in group L ( P ＜ 0.05 or 0.01) . There was no significant difference in BIS value when the patients lost consciousness between the two groups (P ＞ 0.05). Conclusion Ovarian cycle can affect the sedative effect of propofol in patients, which shows that the sedative effect during the follicular phase is lower than that during the luteal phase.     

靶控输注瑞芬太尼和异丙酚麻醉诱导时镇静催眠效应的相互作用

Objective To investigate the sedative and hypnotic interaction between remifentanil and propofol by target-controlled infusion (TCI) during induction of anesthesia.Methods Third-two ASA Ⅰ or Ⅱpatients,aged 22-63 yr,body mass index 18-25 kg/m2,scheduled for elective surgery under general anesthesia,were randomly divided into 4 groups(n=8 each).Group Ⅰ only received TCI pmpofol.GroupⅡ,Ⅲ,and Ⅳreceived a target concentration of 2,4 or 6 ng/ml remifentanil respectively.While the blood-effect site concentrations of remifentanil were equilibrated,patients received TCI of propefol,with an initial target concentration of 0.5μg/ml.After the blood-effect site concentrations of propofol were equilibrated then with 0.5μg/ml increments until the loss consciousness was achieved.The eyelash reflex and state of consciousness were assessed and radial arterial blood sample 6 ml was taken every 3 min to determine the remifentanil and propofol concentrations in blood.Propofol and remifentanil concentrations in blood were measured by reversed-phase high-performance liquid chromatography and high-performance liquid chromatography with ultraviolet detection respectively.The sedative and hypnotic interaction between propofol and remifentanil was determined with a pharmacodynamie interaction model by regression analysis and determined using the isobolographic method.Results Propofol concentrations in blood were lower in group Ⅱ,Ⅲ and Ⅳ than group Ⅰ(P<0.05).The propofol concentratopms in blood were significantly decreased in trun with the increase in the remifentanil concentrations in blood in group Ⅱ-Ⅳ(P<0.05).At loss of eyelash reflex and loss of consciousness of patients,the pharmacodynamic interaction model by curve fitting was superior to linear regression (P<0.05).At loss of eyelash reflex of patients,the curve fitting result showed EC50,prop=2.77μg/ml and EC50,rem=26.67 ng/ml,and the isobolographic method equation is ECprop/2.77+ECrem/26.67=0.69.At loss of consciousness of patients,the curve fitting result showed EC50,prop==3.76μg/ml and EC50,rem=31.56ng/ml,and the isobolographic method equation is Ecprop/3.76+Ecrem/31.56=0.65.Conclusion Remifentanil (Cp 2-6 ng/ml) and propofol by TCI shows a synergistic type of pharmacodynamic interaction on the sedative and hypnotic during induction of anesthesia.     

靶控输注瑞芬太尼和异丙酚麻醉诱导时镇静催眠效应的相互作用

Objective To investigate the sedative and hypnotic interaction between remifentanil and propofol by target-controlled infusion (TCI) during induction of anesthesia.Methods Third-two ASA Ⅰ or Ⅱpatients,aged 22-63 yr,body mass index 18-25 kg/m2,scheduled for elective surgery under general anesthesia,were randomly divided into 4 groups(n=8 each).Group Ⅰ only received TCI pmpofol.GroupⅡ,Ⅲ,and Ⅳreceived a target concentration of 2,4 or 6 ng/ml remifentanil respectively.While the blood-effect site concentrations of remifentanil were equilibrated,patients received TCI of propefol,with an initial target concentration of 0.5μg/ml.After the blood-effect site concentrations of propofol were equilibrated then with 0.5μg/ml increments until the loss consciousness was achieved.The eyelash reflex and state of consciousness were assessed and radial arterial blood sample 6 ml was taken every 3 min to determine the remifentanil and propofol concentrations in blood.Propofol and remifentanil concentrations in blood were measured by reversed-phase high-performance liquid chromatography and high-performance liquid chromatography with ultraviolet detection respectively.The sedative and hypnotic interaction between propofol and remifentanil was determined with a pharmacodynamie interaction model by regression analysis and determined using the isobolographic method.Results Propofol concentrations in blood were lower in group Ⅱ,Ⅲ and Ⅳ than group Ⅰ(P<0.05).The propofol concentratopms in blood were significantly decreased in trun with the increase in the remifentanil concentrations in blood in group Ⅱ-Ⅳ(P<0.05).At loss of eyelash reflex and loss of consciousness of patients,the pharmacodynamic interaction model by curve fitting was superior to linear regression (P<0.05).At loss of eyelash reflex of patients,the curve fitting result showed EC50,prop=2.77μg/ml and EC50,rem=26.67 ng/ml,and the isobolographic method equation is ECprop/2.77+ECrem/26.67=0.69.At loss of consciousness of patients,the curve fitting result showed EC50,prop==3.76μg/ml and EC50,rem=31.56ng/ml,and the isobolographic method equation is Ecprop/3.76+Ecrem/31.56=0.65.Conclusion Remifentanil (Cp 2-6 ng/ml) and propofol by TCI shows a synergistic type of pharmacodynamic interaction on the sedative and hypnotic during induction of anesthesia.     

不同效应室靶浓度瑞芬太尼对患者异丙酚镇静效应的影响

目的 探讨不同效应室靶浓度瑞芬太尼对患者异丙酚镇静效应的影响.方法择期全麻手术患者50例,年龄20～55岁,体重48～86 kg,性别不限,ASA分级Ⅰ或Ⅱ级,BMI＜30 kg/m2,采用随机数字表法,将患者随机分为5组(n=10):R0组、R1组、R2组、R3组、R4组.麻醉诱导时R0组～R4组瑞芬太尼效应室靶浓度分别为0、2 4 6和8 ng/ml,异丙酚初始效应室靶浓度2.0 μg/ml,待效应室浓度稳定之后每隔1 min增加0.5 μg/ml,直至BIS值降至50.记录患者意识消失时的BIS值、异丙酚效应室浓度.记录BIS值降至50时的异丙酚效应室浓度、异丙酚总用量及所需时间.结果 与R0组比较,R2组～R4组意识消失时BIS值升高,异丙酚效应室浓度降低,BIS值降至50时异丙酚总用量和异丙酚效应室浓度降低,所需时间缩短(P＜0.05或0.01),R.组上述指标差异无统计学意义(P＞0.05);R2组～R4组意识消失时BIS值和异丙酚效应室浓度、BIB值降至50时异丙酚总用量和异丙酚效应室浓度以及所需时间差异无统计学意义(P＞0.05).结论 瑞芬太尼效应室靶浓度达4 ng/ml时可增强异丙酚的镇静效应,且4、6和8 ng/ml时该作用无差异.

Abstract：

Objective To investigate the effects of different target effect-site concentrations (Ces) of remifentanil on the sedative effect of propofol. Methods Fifty ASA Ⅰ or Ⅱ patients aged 20-55 yr weighing 48-86 kg with body mass index ＜ 30 kg/m2 were randomly divided into 5 groups ( n = 10 each) . Anesthesia was induced with TCI of remifentanil (Ce = 0, 2, 4, 6 and 8 ng/ml in groups R0-R4 respectively) and propofol. The initial Ce of propofol was 2.0 μg/ml in the 5 groups, and then the Ce of propofol increased by 0.5 μg/ml every 1 min until BIS value decreased to 50. BIS value and Ce of propofol were recorded as the patient lost consciousness. The effect-site concentration and consumption of propofol and the time required were recorded when BIS value decreased to 50.Results BIS value was significantly increased, while the effect-site concentration of propofol was significantly decreased as the patient lost consciousness, and the effect-site concentration and consumption of propofol were significantly decreased and the time required was shortened when BIS value decreased to 50 in R2-R4 groups compared with group R0 (P ＜ 0.05 or 0.01) . Conclusion The sedative effect of propofol can be enhanced when the Ce of remifentanil reaches 4 ng/ml, and the effects are comparable when the Ce of remifentanil reaches 4, 6 and 8 ng/ml.     

靶控输注国产与进口异丙酚药效学的比较

目的 比较靶控输注国产与进口异丙酚的药效学.方法 采用随机、双盲、交叉试验设计.择期拟行肌袢代瓣术的双下肢深静脉瓣膜功能不全患者18例,年龄45～55岁,体重指数18.5～22.9 kg/m2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,患者随机进人流程Ⅰ或流程Ⅱ,一期手术麻醉诱导时应用进口异丙酚,二期手术应用国产异丙酚为流程Ⅰ,反之为流程Ⅱ.异丙酚血浆靶浓度从0.5μg/ml开始,血浆浓度和效应室浓度平衡后,以0.5μg/ml递增,直至效应室浓度达3.5μg/ml,静脉注射瑞芬太尼2μg/kg、罗库溴铵0.6 mg/kg诱导气管插管后行机械通气.记录效应室浓度为0、0.5、1.0、1.5、2.0、2.5、3.0和3.5μg/ml时BIS值、呼吸频率、SpO2和血液动力学指标,患者意识消失时记录异丙酚用量和效应室浓度,采用概率单位法计算5%、50%及95%患者意识消失时的效应室浓度和BIS值,观察不良反应的发生情况.结果 相同效应室浓度国产和进口异丙酚靶控输注时,患者BIS值、呼吸频率、SpO2和血液动力学各指标差异无统计学意义(P＞0.05);5%、50%及95%患者意识消失时国产和进口异丙酚的BIS值和效应室浓度比较差异无统计学意义(P＞0.05);国产和进口异丙酚的药物用量及不良反应发生率比较差异无统计学意义(P＞0.05).结论 国产异丙酚与进口异丙酚具有临床生物等效性.

Abstract：

Objective To compare the clinical pharmacodynamics of domestic and imported propofol by target-controlled infusion. Methods This was a prospective,randomized,double-blind,cross-over study. Eighteen ASA Ⅰ or Ⅱ patients aged 45-55 yr undergoing substitute valve operation for severe deep venous were randomly divided into sequential Ⅰ and Ⅱ , in sequence Ⅰ , the imported propofol was applied in the first stage of surgery and then domestic propofol in the second stage surgery, while in sequence Ⅱ the order was reversed. The target plasma concentration of propofol was initially set at 0.5 μg/ml, followed by increments of 0.5 μg/ml when the effect-site concentration and plasma concentrations was balanced, until the predicted effect-site concentrations reached 3.5 μg/ml. BIS value, RR, SpO2 and hemodynamics were recorded at 0,0.5, 1.0,1.5,2.0,2.5,3.0 and 3.5 μg/ml effect-site concentration level, the predicted effect-site concentrations and the BIS value at loss of consciousness in 5%, 50% and 95% of the patients were calculated. Adverse reactions were recorded during the trial period.Results Under the same effect-site concentration,there was no significant difference in BIS value,RR, SpO2 and hemodynamic monitoring indicators between the two drugs( P ＞ 0.05). There was no significant difference in predicted effect-site concentrations of propofol, the BIS value at loss of consciousness in 5%, 50% and 95% of the patients and the incidence of adverse reaction between the two drugs ( P ＞ 0.05). Conclusion The domestic propofol and imported propofol have clinical bioequivalence.     

BIS监测异丙酚复合瑞芬太尼全麻患儿麻醉深度的准确性

目的 评价脑电双频谱指数(BIS)监测异丙酚复合瑞芬太尼全麻患儿麻醉深度的准确性.方法 择期手术患儿60例,ASA Ⅰ或Ⅱ级,年龄3～8岁,体重14～40kg,随机分为4组(n=15),人室后开放手背静脉,稳定5 min.C组静脉输注0.9%生理盐水0.2 ml·kg-1·h-1;R1组、R2组和R3组分别静脉输注瑞芬太尼0.1、0.3或0.5 μg·kg-1·min-1,瑞芬太尼或生理盐水输注10 min开始靶控输注异丙酚,起始效应室浓度为1 μg/ml,逐渐递增至2、3、4μg/ml.分别于稳定5min、瑞芬太尼静脉输注10min、异丙酚效应室浓度达到l、2、3、4μg/ml稳定1 min及意识消失时记录BIS和警觉,镇静(OAA/S)评分;记录意识消失时间.采用logistic回归法计算意识消失时的BIS50、BIS95和意识消失时异丙酚的EC50、EC95.BIS与OAA/S评分、异丙酚效应室浓度作直线相关分析.结果 C组、R1.组、R2组和R3组BIS与OAA/S评分均呈正相关,r分别为0.89、0.90、0.87、0.82(P<0.05);BIS与异丙酚效应室浓度均呈负相关,r分别为-0.87、-0.90、-0.87、-0.92(P<0.05);与C组比较,其余3组患儿意识消失时异丙酚效应室浓度降低,意识消失时间缩短,R2组和R3组意识消失时BIS升高,BIS50和BIS95升高,异丙酚EC50和EC95降低(P<0.05);与R1组比较,R2组BIS50和BIS95升高,R3组异丙酚EC50和EC95降低(P<0.05).结论 瑞芬太尼复合异丙酚麻醉下,采用BIS监测患儿麻醉深度存在一定局限性.     

复合异丙酚麻醉时舒芬太尼抑制强直电刺激和切皮诱发胸腹部手术患者体动反应的药效学

目的 探讨复合异丙酚麻醉时舒芬太尼抑制强直电刺激和切皮诱发胸腹部手术患者体动反应的药效学.方法 择期胸腹部手术患者50例,年龄18～57岁,ASA分级Ⅰ或Ⅱ级,体重为标准体重的80%～120%,随机分为5组(n=10):舒芬太尼效应室靶浓度0.07、0.10、0.14、0.20和0.28 ng/ml组.靶控输注异丙酚,血浆靶浓度3.0～3.2 μg/ml,患者意识消失时各组按设定的效应室靶浓度靶控输注舒芬太尼,待效应室和血浆浓度达平衡后,给予强直电刺激(频率50 Hz,强度80 mA,波宽0.25ms),观察患者反应后给肌松药,行气管插管,维持上述异丙酚和舒芬太尼的靶浓度到切皮后4 min,试验观察结束.观察强直电刺激和切皮时患者的体动反应情况.采用通过概率单位回归分析法计算舒芬太尼抑制电刺激和切皮诱发的体动反应的半数有效效应室靶浓度(EC50)和EC95及其95%可信区间.结果 复合异丙酚麻醉时舒芬太尼抑制强直电刺激诱发的体动发应的EC50和EC95及其95%可信区间分别为0.12(0.09～0.14)ng/ml和0.20(0.17～0.31)ng/ml,抑制切皮诱发的体动发应的EC50和EC95分别为0.13(0.11～0.16)ng/ml和0.21(0.17～0.29)ng/ml;复合异丙酚麻醉时舒芬太尼抑制强直电刺激和切皮诱发的体动发应的EC50和EC95的比较差异无统计学意义(P＞0.05).结论 复合异丙酚麻醉时舒芬太尼抑制强直电刺激(频率50 Hz,强度80 mA,波宽0.25 ms)诱发的体动发应的EC50和EC95分别为0.12和0.20 ng/ml,抑制切皮诱发的体动发应的EC50和EC95分别为0.13和0.21 ng/ml,且抑制两组刺激诱发的体动发应的药效学无差异,提示强直电刺激可替代切皮用于评价麻醉药的药效学.     

新辅助化疗乳腺癌患者靶控输注依托咪酯意识消失时效应室靶浓度的EC50

目的 测定新辅助化疗后患者靶控输注(target-controlled infusion,TCI)依托咪酯意识消失时的半数效应室靶浓度(EC50).方法 90例ASA Ⅰ或Ⅱ级,同时期行乳腺癌切除手术的乳腺癌患者,根据术前是否接受新辅助化疗以及化疗方案分为未化疗组(Ⅰ组),紫杉醇化疗4周期组(Ⅱ组),药物联合化疗4周期...     

人工流产术患者复合异丙酚时靶控输注瑞芬太尼的药效学

目的 探讨人工流产术患者复合异丙酚4.5 μg/ml时靶控输注瑞芬太尼的药效学.方法 拟行人工流产术患者135例,年龄18～30岁,ASAI级,孕6～10周.随机分为9组(n=15):瑞芬太尼效应室靶浓度分别为0.5、0.8、1.1、1.4、1.7、2.0、2.3、2.6和2.9 ng/ml(Ⅰ组～Ⅸ组).各组异丙酚效应室靶浓度均为4.5 μg/ml.采用概率单位回归分析法,计算麻醉效果达优时瑞芬太尼效应室靶浓度EC50、EC95及其95%可信区间(CI)和呼吸抑制时瑞芬太尼效应室靶浓度EC50、EC95及其95%CI.结果 麻醉效果达优时瑞芬太尼的效应室靶浓度EC50为1.67 ng/ml,其95%CI为1.45～1.90 ng/ml,EC95为3.88 ng/ml,其95%CI为3.08～5.89 ng/ml;呼吸抑制时瑞芬太尼效应室靶浓度EC50为2.44 ng/ml,其95%CI为2.28～2.64 ng/ml,EC95为3.36 ng/ml,其95%CI为2.99～4.34 ng/ml.麻醉效果达优时瑞芬太尼的效应室靶浓度EC95高于呼吸抑制时效应室靶浓度EC95(P＜0.05).结论 人工流产术患者复合异丙酚4.5 μg/ml时,麻醉效果达优时瑞芬太尼的效应室靶浓度EC50、EC95,分别为1.67、3.88 ng/ml,呼吸抑制时瑞芬太尼的效应室靶浓度EC50、EC95,分别为2.44、3.36 ng/ml.     

靶控输注异丙酚时瑞芬太尼抑制患者喉罩置管反应的药效学

目的 探讨TCI异丙酚时瑞芬太尼抑制患者喉罩置管反应的药效学.方法 择期乳腺纤维瘤切除术患者36例,年龄18～59岁,ASA分级Ⅰ或Ⅱ级,BMI＜30 kg/m2.采用序贯法进行试验,TCI异丙酚,Ce为4.0μg/ml,待患者意识消失后,TCI瑞芬太尼,初始Ce 2.9 ng/ml,待Ce与血浆浓度达平衡后3 min置入喉罩,相邻Ce之比为1.2.喉罩置入成功的标准为:Muzi评分≤2分且喉罩置入后3 min内MAP和HR升高不超过基础值水平的15%.结果 瑞芬太尼抑制喉罩置管反应的EC50为2.75ng/ml,95%可信区间为2.51～3.01 ng/ml.结论 TCI异丙酚Ce为4.0μg/ml时瑞芬太尼抑制患者喉罩置管反应的EC50为2.75 ng/ml.     

Relationship between bispectral index,auditory evoked potential index and effect-site EC50 for propofol at two clinical end-points

Background. Many anaesthetists are deterred from using totali.v. anaesthesia because of uncertainty over the concentrationof propofol required to prevent awareness. We predicted bloodand effect-site concentrations of propofol at two clinical end-points:loss of consciousness and no response to a painful stimulus. Methods. Forty unpremedicated Caucasian patients were anaesthetizedwith i.v. propofol delivered by a Diprifusor target-controlledinfusion (TCI). Bispectral index (BIS) and auditory evoked potentialindex (AEPex) were measured and blood and effect-site propofolconcentrations were predicted. Logistic regression was usedto estimate population values for predicted blood and effect-sitepropofol concentrations at the clinical end-points and to correlatethese with BIS and AEPex. Results. The effect-site EC₅₀ at loss of consciousness was 2.8 µm ml^–1with an EC₀₅ and an EC₉₅ of 1.5 and 4.1 µm ml^–1,respectively. The predicted EC₅₀ when there was no responseto a tetanic stimulus was 5.2 µm ml^–1 withan EC₀₅ and an EC₉₅ of 3.1 and 7.2 µm ml^–1,respectively. Conclusions. Unconsciousness and lack of response to a painfulstimulus occur within a defined range of effect-site concentrations,predicted by Diprifusor TCI software. Br J Anaesth 2003; 90: 127–31     

Propofol and remifentanil effect-site concentrations estimated by pharmacokinetic simulation and bispectral index monitoring during craniotomy with intraoperative awakening for brain tumor resection

Different anesthetic techniques have been suggested for craniotomy with intraoperative awakening. We describe an asleep-awake-asleep technique with propofol and remifentanil infusions, with pharmacokinetic simulation to predict the effect-site concentrations and to modulate the infusion rates of both drugs, and bispectral index (BIS) monitoring. Five critical moments were defined: first loss of consciousness (LOC1), first recovery of consciousness (ROC1), final of neurologic testing (NT), second loss of consciousness (LOC2), and second recovery of consciousness (ROC2). At LOC1, predicted effect-site concentrations of propofol and remifentanil were, respectively, 3.6+/-1.2 microg/mL and 2.4+/-0.4 etag/mL. At ROC1, predicted effect-site concentrations of propofol and remifentanil were, respectively, 2.1+/-0.3 microg/mL and 1.8+/-0.3 etag/mL. At NT, predicted effect-site concentrations of propofol and remifentanil were, respectively, 0.9+/-0.3 microg/mL and 1.8+/-0.2 etag/mL. At LOC2, predicted effect-site concentrations of propofol and remifentanil were, respectively, 2.1+/-0.2 microg/mL and 2.5+/-0.2 etag/mL. At ROC2, predicted effect-site concentrations of propofol and remifentanil were, respectively, 1.2+/-0.5 microg/mL and 1.4+/-0.2 etag/mL (data are mean+/-SE). A significative correlation was found between BIS and predicted effect-site concentrations of propofol (r=0.547, P<0.001) and remifentanil (r=0.533, P<0.001). Multiple regression analysis between BIS and propofol and remifentanil predicted effect-site concentrations at the different critical steps of the procedure was done and found also significative (r=0.7341, P<0.001).     

急性高容量血液稀释对患者靶控输注异丙酚意识消失时EC50的影响

目的 探讨急性高容量血液稀释(AHHD)对患者靶控输注(TCI)异丙酚意识消失时EC50的影响.方法 择期行脊柱手术或全髋置换术患者60例,年龄18～64岁,ASA Ⅰ或Ⅱ级,随机分为4组(n=15):异丙酚血浆靶浓度输注组(Tp组)、异丙酚效应室靶浓度输注组(Te组)、AHHD+Tp组和AHHD+Te组.入室后经30 min外周静脉输注乳酸钠林格氏液0.7 nl·kg-1·h-1,AHHD+Tp组和AHHD+Te组同时经颈内静脉输注4%琥珀酰明胶15 ml/kg行AHHD.AHHD结束后TCI异丙酚,初始靶浓度为1.2μg/ml,到达该浓度30 S后,采用警觉/镇静评分(OAA/S)评价患者的意识状态,然后以0.3 μg/ml的浓度梯度增加靶浓度,直至患者意识消失(OAA/S=0分),记录此时异丙酚的血浆靶浓度和效应室靶浓度.采用概率单位法计算异丙酚意识消失时的EC50及其95%可信区间(CI).结果 Tp组、Te组、AHHD+Tp组和AHHD+Te组意识消失时异丙酚的EC50及其95%CI分别为3.74(3.46～4.16)、2.32(2.17～2.42)、4.12(3.81～4.32)、2.38(2.14～2.56)μg/ml.与Tp组比较,AHHD+Tp组意识消失时异丙酚的EC50升高(P<0.05);与Te组相比,AHHD+Te组意识消失时异丙酚的EC50差异无统计学意义(P>0.05).结论 AHHD可升高患者TCI异丙酚意识消失时血浆靶浓度的EC50,对效应室靶浓度的EC50无影响.     

右美托咪啶对瑞芬太尼抑制切皮时患者体动反应半数有效效应室靶浓度的影响

目的 评价右美托咪啶对瑞芬太尼抑制切皮时患者体动反应半数有效效应室靶浓度(EC50)的影响.方法 择期拟行乳房肿瘤切除术患者40例,年龄20～50岁,体重45～58 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其随机分为瑞芬太尼组(R组)和右美托咪啶复合瑞芬太尼组(RD组),每组20例.R组和RD组切皮前分别静脉输注生理盐水和右美托咪啶1.0μg/kg,输注时间10min,同时靶控输注异丙酚,血浆靶浓度设为3.0 mg/L,13 min后开始靶控输注瑞芬太尼.采用序贯法进行试验,RD组和R组初始效应室靶浓度分别为2.5和3.0μg/L,待两药浓度均达靶浓度后切开皮肤3 cm,有体动反应,则下一例采用高一级浓度,无体动反应,则下一例患者采用低一级浓度,相邻浓度比值为1.2,发生体动反应的标准为患者出现躯干、四肢或头颈可见的运动.计算瑞芬太尼抑制患者体动反应的EC50及其95％可信区间.结果 RD组瑞芬太尼抑制切皮时体动反应的EC50为1.7 μg/L,95％可信区间为1.5～1.9 μg/L,R组瑞芬太尼抑制切皮时体动反应的EC50为2.5 μg/L,95％可信区间为2.2～2.7 μg/L,差异有统计学意义(P＜0.01).结论 靶控输注异丙酚(血浆靶浓度3.0 mg/L)下,静脉输注右美托咪啶1.0μg/kg可降低瑞芬太尼抑制切皮时患者体动反应的EC50.