复合TCI异丙酚时瑞芬太尼抑制支撑喉镜诱发心血管反应的EC50

目的 探讨复合TCI异丙酚时瑞芬太尼抑制支撑喉镜诱发心血管反应的半数有效血浆靶浓度(EC50).方法 择期拟行全麻下声带息肉摘除术患者20例,ASAⅠ或Ⅱ级,年龄20～51岁,体重52～83 kg,TCI瑞芬太尼和异丙酚行麻醉诱导,异丙酚血浆靶浓度4μg/ml,瑞芬太尼血浆靶浓度采用序贯法确定,第1例患者瑞芬太尼的血浆靶浓度5ng/ml,相邻靶浓度之比为1.2,以HR或MAP变化幅度超过基础状态15%为心血管反应阳性的判断标准.气管插管后3 min置人支撑喉镜.计算瑞芬太尼抑制支撑喉镜诱发心血管反应的EC50及其95%可信区间(CI).结果 所有患者均未见胸壁僵硬,均未发生术中知晓.瑞芬太尼抑制支撑喉镜诱发心血管反应的EC50为3.50 ng/ml,95%CI为3.47～3.60 ng/ml.结论 复合TCI异丙酚4μg/ml时瑞芬太尼抑制支撑喉镜诱发心血管反应的EC50为3.50 ng/ml,95%CI为3.47～3.60 ng/ml.     

复合TCI异丙酚时瑞芬太尼抑制支撑喉镜诱发心血管反应的EC50

Objective To determine the median effective concentration(EC50) of remifentanil by TCI inhibiting the cardiovascular response to the placement of operating laryngoscope performed under propofol anesthesia administered by TCI.Methods Twenty ASA Ⅰ orⅡ patients,aged 20-51 yr,weighing 52-83 kg,undergoing extirpation of vocal cord polyps under general anesthesia with remifentanil-pmpofol administered by TCI.were enrolled in the study.The target plasma concentration (Cp) of propofol was set at 4μg/ml.Operating laryngoscope was placed at 3 min after tracheal intubation.HR and MAP were continuously monitored.When HR or MAP increased by 15%,the candiovascular response was defined as positive.The EC50 was determined by up-and-down technique.The initial Cp of remifentanil was set at 5 ng/ml and was increased/decreased by 20%in the next patient if the cardiovascular response was positive or negative.Results No chest wall stiffness and intraoperative awareness occurred in all the patients.The EC50 of remifentanil TCI inhibiting the cardiovascular response to the placement of operating laryngoscope was 3.50ng/ml with confidence interval(CI) between 3.47-3.60 ng/ml.Conclusion Thee EC50 of remifentanil TCI inhibiting cardiovascular response to the placement of operating laryngoscope is 3.50ng/ml with CI between 3.47-3.60ng/ml.     

复合TCI异丙酚时瑞芬太尼抑制纤维支气管镜检查患者气道反应的半数有效血浆靶浓度

目的 确定复合TCI异丙酚时瑞芬太尼抑制纤维支气管镜检查患者气道反应的半数有效血浆靶浓度(EC50).方法 择期行纤维支气管镜检查患者40例,ASA分级Ⅰ或Ⅱ级,随机分为2组(n=20).两组均以TCI瑞芬太尼和异丙酚麻醉,异丙酚效应室靶浓度3μg/ml,瑞芬太尼效应室靶浓度采用序贯法确定,第1例患者瑞芬太尼的效应室靶浓度5μg/L,相邻靶浓度之比为1.1.A组以检查过程中BIS≤60为合适麻醉深度,B组以检查过程中气道反应≤Ⅱ级为合适麻醉深度.分别计算两组瑞芬太尼抑制气道反应的EC50及其95%可信区间(CI).结果 A组和B组瑞芬太尼的EC50及其95%CI分别为4.50μg/L(95%CI 3.88～5.36μg/L)和4.10ug/L(95%CI 3.31～5.00μg/L),A组EC50高于B组(P＜0.05).结论 复合TCI异丙酚(效应室靶浓度为3μg/L)时,瑞芬太尼抑制纤维支气管镜检查患者气道反应的EC50为4.10μg/L.BIS不适宜作为反映异丙酚复合瑞芬太尼麻醉深度的指标.     

复合异丙酚时瑞芬太尼抑制维吾尔族患者气管插管及切皮反应的半数有效血浆浓度

目的 确定复合异丙酚时瑞芬太尼抑制维吾尔族患者气管插管及切皮反应的半数有效血浆浓度(EC50).方法 择期拟行腹腔镜胆囊切除术维吾尔族患者30例,ASA分级Ⅰ或Ⅱ级,年龄20～60岁,体重指数18～ 30 kg/m2.静脉输注异丙酚维持BIS值40～ 50时,TCI瑞芬太尼,初始Cp 6.0ng/ml,待Ce与Cp达平衡后静脉注射顺式阿曲库铵0.2 mg/kg,2 min后行气管插管.患者气管插管后初始Cp为6.0 ng/ml,待Ce与Cp达平衡后开始切皮.发生气管插管反应和(或)切皮反应,则下一例患者采用高一级浓度,否则采用低一级浓度,浓度梯度为0.5 ng/ml.发生气管插管反应和(或)切皮反应的标准:收缩压升高超过基础值15％和(或)心率＞90次/min且持续时间＞15s.计算瑞芬太尼抑制气管插管及切皮反应的EC50及其95％可信区间(CI).结果 复合异丙酚维持BIS值40 ～ 50时瑞芬太尼抑制气管插管及切皮反应的EC50及其95％ CI分别为3.4(2.3 ～ 4.5) ng/ml和3.8(2.8～4.9) ng/ml.结论 复合异丙酚维持BIS值40～50时瑞芬太尼抑制维吾尔族患者气管插管及切皮反应的EC50分别为3.4和3.8 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.     

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.     

异丙酚靶控输注时瑞芬太尼抑制气管插管反应的半数有效血浆浓度

目的测定异丙酚靶控输注时瑞芬太尼抑制气管插管反应的半数有效血浆浓度。方法择期手术病人20例,瑞芬太尼靶控输注2 min后,输注血浆靶浓度为3 mg·L-1的异丙酚,病人意识消失后给予罗库溴铵行气管插管。瑞芬太尼血浆靶浓度按序贯法确定,相邻血浆靶浓度之间比率为 1．2。结果瑞芬太尼抑制气管插管反应的半数有效血浆浓度为2．6μg·L-1,95％可信区间为2．4- 2．8μg·L-1。结论在复合靶控输注3 mg·L-1异丙酚时,瑞芬太尼抑制气管插管反应的半数有效血浆靶控浓度为2．6μg·L-1。     

异丙酚麻醉下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

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,年龄加～65岁,体重40～75 kg,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、6 ng/ml;异丙酚TCI,效应室靶浓度均为4.0μg/mI。病人意识消失后静脉注射维库溴铵0.15 mg/kg,气管插管。插管后2 min暂停瑞芬太尼TCI,切皮前10 min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2 min内最高、切皮前1 min、切皮后2 min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2 min内最高值、切皮前1 min与切皮后2 min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EC95。结果瑞芬太尼抑制气管插管时心血管反应的EC50为4.41 ng/ml,95%可信区间(95%CI)为3.97～5.05 ng/ml;相应的EC95为6.42 ng/ml,95%CI为5.54～8.09 ng/ml。瑞芬太尼抑制切皮时心血管反应的EC50为2.05 ng/ml,95%CI为1.36～2.59 ng/ml;相应的EC95为3.89 ng/ml,95%CI为3.20～5.71 ng/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4.41 ng/ml和2.05 ng/ml。     

复合靶控输注异丙酚时瑞芬太尼抑制重症肌无力患者气管插管反应的药效学

目的 探讨复合靶控输注异丙酚时瑞芬太尼抑制重症肌无力患者气管插管反应的药效学.方法 拟行经胸骨正中劈开胸腺切除术的重症肌无力患者45例,ASA Ⅰ或Ⅱ级,TCI异丙酚和瑞芬太尼进行麻醉诱导,异丙酚血浆靶浓度为4 μg/ml,瑞芬太尼初始效应室靶浓度(Ce)为1.8 ng/ml,依次按2.7、4.0、6.0 ng/ml梯度递增,至患者可耐受喉麻管置入声门下进行气管内表麻后,进行气管插管.采用概率单位回归分析法分别计算瑞芬太尼抑制气管插管反应的Ce50和Ce95.结果 瑞芬太尼抑制气管插管反应的Ce50为2.2 ng/ml,其95%可信区间为2.0～2.3 ng/ml;抑制气管插管反应的Ce95为3.0 ng/ml,其95%可信区间为2.8～3.5 ng/ml.结论 复合靶控输注异丙酚(血浆靶浓度为4 μg/ml)时,瑞芬太尼抑制重症肌无力患者气管插管反应的Ce50和Ce95分别为2.2、3.0 ng/ml.     

老年病人瑞芬太尼复合异丙酚靶控输注全凭静脉麻醉的效果

目的比较成年和老年病人瑞芬太尼复合异丙酚靶控输注(TCI)全凭静脉麻醉的效果。方法全麻下择期行骨科手术病人40例,ASAⅠ～Ⅲ级,分为Ⅰ组(＜65岁)和Ⅱ组(≥65岁),每组20例。入室后(基础值,T_1)静脉输注乳酸钠林格氏液5 ml／kg,效应室靶浓度TCI(T_2)瑞芬太尼从1．0ng／ml渐升至4．0ng／ml后启动异丙酚TCI,从1．0μg／ml血浆靶浓度渐升至4．0μg／ml(T_3),气管插管后即刻(T_4)、切皮前3 min瑞芬太尼和异丙酚靶浓度分别调整为3．0ng／ml、3．0μg／ml。记录平均动脉压(MAP)、心率(HR)、听觉诱发电位指数(AAI)、双频谱指数(BIS),不良反应发生率、辅助药物使用次数、苏醒指标、拔除气管导管后即刻(T_6)及回病房后即刻视觉模拟疼痛评分(VAS)等。结果与Ⅰ组比较,Ⅱ组T_(2,3)时BIS降低,T_(4,5)时MAP、HR降低,心动过缓发生率、麻黄碱、阿托品使用率升高(P＜0．05),不良反应发生率差异无统计学意义。LOC时Ⅰ组和Ⅱ组异丙酚血浆靶浓度分别为2．5±0．7、(1．2±0．5)μg／ml,瑞芬太尼效应室靶浓度Ⅰ组和Ⅱ组分别为3．5±0．4、(3．3±0．4)ng／ml(P＞0．05),异丙酚4μg／ml开始至LOC的时间两组分别为130±60、(82±29)s(P＜0．01),BIS分别为52±11、46±12,AAI为40±25、30±7。Ⅰ组停药至自主呼吸、指令反应恢复时间及拔管、离室时间均早于Ⅱ组(P＜0．05)。回病房后即刻VAS评分Ⅱ组低于Ⅰ组(P＜0．05)。结论瑞芬太尼复合异丙酚TCI全凭静脉麻醉可提供老年病人骨科手术满意的麻醉效应,但需密切观察血液动力学变化。     

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.     

复合异丙酚时舒芬太尼抑制维吾尔族患者气管插管心血管反应的半数有效效应室靶浓度

目的 确定复合异丙酚时舒芬太尼抑制维吾尔族患者气管插管心血管反应的半数有效效应室靶浓度(EC50).方法 全身麻醉下择期手术的维吾尔族患者31例,年龄21～59岁,性别不限,BMI 18～28 kg/m2,ASA分级Ⅰ或Ⅱ级.麻醉诱导:靶控输注异丙酚,效应室靶浓度为3.0 μg/ml,静脉注射顺阿曲库铵0.2 mg/kg,靶控输注舒芬太尼,第1例患者效应室靶浓度为0.8 ng/ml,待效应室靶浓度与血浆靶浓度达平衡后行气管插管,发生气管插管心血管反应时,则下一例患者采用高一级浓度,否则采用低一级浓度,浓度梯度的比值为1.1.发生气管插管心血管反应的标准:收缩压升高幅度超过基础值15％和(或)心率＞90次/min且持续时间＞15s.采用Probit概率回归法计算舒芬太尼抑制气管插管心血管反应的EC50及其95％可信区间.结果 复合异丙酚时舒芬太尼抑制维吾尔族患者气管插管心血管反应的EC50及其95％可信区间为0.46(0.43～0.49)ng/ml.结论 复合异丙酚时,舒芬太尼抑制维吾尔族患者气管插管心血管反应的EC50为0.46 ng/ml.     

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.