右美托咪啶对舒芬太尼抑制甲状腺切除术患者切皮时体动反应半数有效效应室靶浓度的影响

目的 评价右美托咪啶对舒芬太尼抑制甲状腺切除术患者体动反应的半数有效效应室靶浓度(EC50)的影响.方法 择期行甲状腺双叶次全切除术患者,性别不限,ASA分级Ⅰ或Ⅱ级,年龄20～64岁,体重指数20～2.5 kg/m2,采用随机数字表法,将其随机分为2组,D组经10 min静脉输注右美托咪啶0.6 μg/kg,C组给予等容量生理盐水,停止给药后5 min时开始靶控输注异丙酚,血浆靶浓度为3.0 μg/ml,输注10 min时,2组开始靶控输注舒芬太尼,第1例患者的效应室靶浓度为0.20ng/ml,输注舒芬太尼3 min时置入喉罩,保留自主呼吸,待舒芬太尼达到目标靶浓度后,开始手术.根据切皮时是否发生体动反应确定下一例患者舒芬太尼的靶浓度,相邻靶浓度比值为1.2.采用序贯法计算舒芬太尼抑制切皮时体动反应的EC50及其95%可信区间(95%CI).结果 C组和D组样本数分别为19和20,舒芬太尼抑制切皮时体动反应的EC50分别为0.1454 ng/ml(95%CI 0.1339～0.1580 ng/ml)和0.1148 ng/ml(95%CI 0.1055～0.1249 ng/ml),D组EC50低于C组(P＜0.05).结论 术前静脉注射右美托咪啶0.6 μg/kg可降低舒芬太尼抑制甲状腺切除术患者切皮时体动反应的EC50.

Abstract：

Objective To investigate the effect of dexmedetomidine on median effective target effect-site concentration ( EC50) of sufentanil inhibiting body movement evoked by skin incision in patients undergoing bilateral subtotal thyroidectomy. Methods Thirty-nine ASA I or II patients of both sexes aged 20-64 yr with a body mass index of 20-25 kg/m2 undergoing bilateral subtotal thyroidectomy were randomly divided into 2 groups: control group (group C) and dexmedetomidine group (group D). The patients were premedicated with intramuscular phenobarbital 0.1 g and scopolamine 0.3 mg. In group D dexmedetomidine 0.6 μg/kg was injected iv over 10 min at S min before induction of anesthesia. Anesthesia was induced with target-controlled infusion (TCI) of propofol and sufentanil. The target plasma concentration of propofol was set at 3.0 μg/ml which was maintained until the end of operation. TCI of sufentanil was started at 10 min after initiation of propofol TCI. The initial target effect-site concentration was set at 0.20 ng/ml and decreased/increased by 20% in the next patient according to whether the patient's body moved or not within 1 min after skin incision. Laryngeal mask airway was inserted at 3 min after initiation of sufentanil TCI. Spontaneous breathing was maintained. Skin incision was made at 10 min after initiation of sufentanil TCI. The EC50 and 95% confidence interval (CI) of sufentanil inhibiting skin incision-evoked body movement were calculated with sequential method. Results EC50, of sufentanil was 0.1148 ng/ml (95% CI 0.1055-0.1249 ng/ml) in group D and 0.1454 ng/ml (95% CI 0.1339-0.1580 ng/ml) in group C, and was significantly lower in group D than in group C. Conclusion Dexmedetomidine 0.6 μg/kg infused iv before operation can reduce the EC50 of sufentanil inhibiting body movement evoked by skin incision in patients undergoing bilateral subtotal thyroidectomy.     

右美托咪啶对异氟醚抑制切皮时患者体动反应的肺泡气最低有效浓度的影响

目的 探讨右美托咪啶对异氟醚抑制切皮时患者体动反应的肺泡气最低有效浓度(MAC)的影响.方法 择期全身麻醉下行上腹部手术患者,年龄40～60岁,ASA分级Ⅰ或Ⅱ级,体重指数22～27 kg/m2,采用随机数字表法,将患者随机分为3组:对照组(C组)、小剂量右美托咪啶组(D1组)和大剂量右美托咪啶组(D2组).麻醉诱导前静脉输注右美托咪啶(生理盐水稀释至15 ml)0.4 μg/kg(D1组)、0.8μg/kg(D2组)及生理盐水15 ml(C组),15 min内输注完毕.静脉注射芬太尼-异丙酚-琥珀酰胆碱麻醉诱导,气管插管后机械通气并开启异氟醚挥发罐.采用序贯法确定麻醉维持期间异氟醚的呼气末浓度,C组、D1组和D2组第1例患者异氟醚呼气末浓度分别设定为1.0%、0.8%和0.6%,当异氟醚呼气末浓度达到预设水平并维持15 min以上,且肌颤搐恢复到对照值90%以上时开始手术,相邻浓度差值为0.2%.于切皮时评估患者体动反应,以各交叉点异氟醚呼气末浓度的均数为MAC,并计算95%可信区间(CI).结果 C组、D1组和D2组入选病例分别为15、17和16例.异氟醚抑制切皮时体动反应的MAC及其95%CI分别为:C组(1.03±0.23)%(95%CI 0.83%～1.21%)、D1组(0.72±0.19)%(95%CI 0.58%～0.85%)、D2组(0.51±0.27)%(95%CI 0.30%～0.71%).与C组比较,D1组和D2组MAC降低(P＜0.01),D2组MAC明显低于D1组(P＜0.05).结论 右美托咪啶可明显降低异氟醚抑制切皮时患者体动反应的MAC,且与剂量有关.

Abstract：

Objective To investigate the effect of dexmedetomidine on minimum alveolar concentration (MAC) of isoflurane required to inhibit the body movement during skin incision. Methods Forty-eight ASA Ⅰ or Ⅱ patients aged 40-60 yr with body mass index of 22-27 kg/m2 undergoing elective upper abdominal surgery under general anesthesia were randomly divided into 3 groups: control group (group C, n = 15);low dose dexmedetomidine group (group D1, n = 17) and high dose dexmedetomidine group (group D2, n = 16). The patients were unpremedicated. Dexmedetomidine 0.4 and 0.8 μg/kg in normal saline (NS) 15 ml was infused over 15 min before induction of anesthesia in D1 and D2 groups respectively. Anesthesia was induced with fentanyl-propofol-succinylcholine. The patients were mechanically ventilated after tracheal intubation. Anesthesia was maintained with isoflurane. MAC of isoflurane was determined by up-and-down technique. The initial end-tidal isofiurane concentration was set at 1.0%, 0.8% and 0.6% in C, D1 and D2 groups respectively. Each time the end-tidal isoflurane concentration was increased/decreased by 0.2%. Skin incision was made after 15 min of equilibration, when the twitch height returned to more than 90% of its control value. Movement of body and limbs including swallowing and coughing were carefully looked for when skin incision was made. MAC of isoflurane was the mean of end-tidal concentration of isoflurane of each crossover pair, and 95 % CI was calculated. Results MAC of isoflurane was significantly decreased in D1 and D2 groups as compared with group C and in group D2 as compared with group D1( P ＜ 0.05 or 0.01 ). Conclusion Dexmedetomidine can significantly decrease MAC of isoflurane required to inhibit the body movement during skin incision in a dose-dependent manner.     

不同剂量右美托咪啶对七氟醚抑制切皮诱发患者体动反应肺泡气最低有效浓度的影响

目的 探讨不同剂量右美托咪啶对七氟醚抑制切皮诱发患者体动反应肺泡气最低有效浓度(MAC)的影响.方法 择期拟在全麻下行下腹部手术患者,性别不限,年龄18～64岁,体重指数21 ～ 27 kg/m2,ASA分级Ⅰ或Ⅱ级.采用随机数字表法,将其随机分为4组:对照组(C组)和不同剂量右美托咪啶组(D1组、D2组和D3组).麻醉诱导前静脉输注右美托咪啶(生理盐水稀释至15 ml)0.2μg/kg(D1组)、0.4 μg/kg(D2组)、0.6μg/kg(D3组)或生理盐水15 ml(C组),30 min内输注完毕.4组均采用吸入七氟醚麻醉诱导,气管插管后行机械通气.采用序贯法确定麻醉维持期间呼气末七氟醚浓度.C组、D1组、D2组及D3组第1例患者呼气末七氟醚浓度分别设定为3.0％、3.0％、2.5％和2.0％,预定呼气末七氟醚浓度稳定15 min时进行切皮.评估患者切皮时体动反应,当发生体动反应时,上调一个浓度梯度,否则下调一个浓度梯度,相邻浓度比值为0.9,根据前一例患者是否发生体动反应确定下一例患者呼气末七氟醚浓度,直至每组出现第7个交叉点.以各交叉点呼气末七氟醚浓度的均数作为MAC值,并计算95％可信区间 (CI).结果 C组、D1组、D2组和D3组入选病例分别18、20、20、22例；C组、D1组、D2组和D3组七氟醚MAC值(95％CI)分别为2.5％(2.3％～2.8％)、1.5％(1.3％～1.7％)、1.3％(1.0％～1.6％)和1.1％(0.7％ ～ 1.5％).与C组比较,D1组～D3组七氟醚MAC值降低(P＜0.05)；与D1组比较,D2组和D3组七氟醚MAC值降低(P＜0.05)；D2组和D3组七氟醚MAC值差异无统计学意义(P＞0.05).结论 右美托咪啶0.2、0.4、0.6 μg/kg可明显降低七氟醚抑制手术患者切皮诱发体动反应的MAC值,且呈剂量依赖性.     

年龄因素对靶控输注右美托咪啶患者意识消失量效关系的影响

目的 评价年龄因素对右美托咪啶靶控输注患者意识消失量效关系的影响.方法 脊椎-硬膜外麻醉下择期拟行下腹部或下肢手术患者60例,ASA分级Ⅰ或Ⅱ级,按照年龄分为中青年组(Y组,18 ～ 55岁)和老年组(O组,65～85岁),每组30例,每组按右美托咪啶靶浓度,采用随机数字表法将患者随机分为5个亚组,每组6例.Y1～5组右美托咪啶血浆靶浓度分别为0.54、0.64、0.76、0.90、1.07 ng/ml;O1-5右美托咪啶血浆靶浓度分别为0.36、0.42、0.51、0.60、0.71 ng/ml,以警觉/镇静评分≤2分和睫毛反射消失作为意识消失标准.记录30 min内每组患者意识消失的例数及其对应靶浓度,采用概率单位法计算两组意识消失的半数有效浓度( EC50)和95％有效浓度(EC95)及其95％可信区间(95％CI).结果 O组右美托咪啶使患者意识消失的EC50及其95％CI为0.478(0.424～0.536) ng/ml,EC95及其95％CI为0.641(0.567 ～ 0.816)ng/ml,Y组右美托咪啶使患者意识消失的EC50及其95％CI为0.738(0.657 ～ 0.827) ng/ml,EC95及其95％CI为0.990(0.874～ 1.267) ng/ml,差异均有统计学意义(P＜0.05).结论 靶控输注右美托咪啶老年患者意识消失的EC50和EC95均低于中青年患者,老年患者对右美托咪啶的镇静效应更敏感.     

不同剂量右美托咪定对靶控输注异丙酚病人意识消失半数有效血浆靶浓度的影响

目的 评价不同剂量右美托咪定对靶控输注异丙酚病人意识消失半数有效血浆靶浓度(EC5o)的影响.方法 择期全麻病人80例,ASA分级Ⅰ或Ⅱ级,年龄18～64岁,体重指数≤25 kg/m2,采用随机数字表法,将病人随机分为4组(n=20):对照组(C组)和不同剂量右美托咪定组(D1～3组).D1～3组分别静脉输注右美托咪定0.4、0.5和0.6 μg/kg,输注时间10 min,C组输注等容量生理盐水.随后靶控输注异丙酚,采用序贯法进行试验,异丙酚初始血浆靶浓度2.0 μg/ml,相邻浓度比值为1.1.意识消失的标准为睫毛反射消失、两次呼之不应.计算异丙酚使病人意识消失的EC50及其95％可信区间(95％CI).观察心动过缓、低血压和呼吸抑制等不良反应的发生情况.结果 C组和D1～3组异丙酚使病人意识消失的EC50及其95％ CI分别为2.59(2.51 ～ 2.67)、2.09(2.02 ～ 2.16)、1.82(1.70 ～1.95)和1.60 (1.49～ 1.72) μg/ml.C组、D1～3组异丙酚使病人意识消失的EC50依次降低(P＜0.05).与C组比较,D1～3组心动过缓和低血压发生率降低(P＜0.05);与D1组比较,D2,3组心动过缓发生率和D3组低血压发生率升高(P＜0.05);D2组和D3组心动过缓和低血压发生率比较差异无统计学意义(P＞0.05).各组无一例病人发生呼吸抑制.结论 靶控输注异丙酚时复合静脉输注右美托咪定0.4 μg/kg为适宜剂量,既可降低靶控输注异丙酚病人意识消失的EC50,又不发生不良反应.     

右旋美托咪啶对丙泊酚靶控输注患者呼吸抑制半数有效浓度的影响

目的研究右旋美托咪啶对丙泊酚靶控输注(TCI)时患者呼吸抑制的半数有效浓度(EC50)的影响。方法 ASAⅠ或Ⅱ级择期全麻手术患者49例,随机分为右旋美托咪啶组(D组)25例和对照组(C组)24例,分别静脉注射右旋美托咪啶0.4μg/kg或生理盐水5ml,10min后开启丙泊酚TCI泵。分别于麻醉前(T1)、输注右旋美托咪啶或生理盐水后1min(T2)、5min(T3)和10min(T4)及丙泊酚TCI启动后1min(T5)、5min(T6)、结束时(T7)记录VT、分钟通气量(MV)、PETCO2、RR、SBP、DBP、ECG、HR、SpO2、脑电双频谱指数(BIS)和警觉/镇静(OAA/S)评分,计算并比较D、C组丙泊酚TCI所致患者呼吸抑制的EC50及镇静程度。结果 D、C组丙泊酚TCI呼吸抑制的EC50分别为2.35μg/ml(95%可信区间为2.31～2.39μg/ml)和2.62μg/ml(95%可信区间为2.52～2.72μg/ml),D组低于C组(P0.05);T3～T7时D组患者的BIS值及T5～T7时OAA/S评分明显低于C组(P0.05)。结论丙泊酚TCI前单次静脉注射0.4μg/kg的右旋美托咪啶能降低丙泊酚TCI患者呼吸抑制的EC50,患者的镇静程度加深。     

右美托咪定局部用药对罗哌卡因臂丛神经阻滞半数有效浓度的影响

目的 通过评价右美托咪定局部用药对罗哌卡因臂丛神经阻滞半数有效浓度(EC50)的影响,探讨其局部用药的镇痛机制.方法 前臂及手部择期手术患者52例,年龄18 ～ 50岁,体重50～80 kg,ASA分级Ⅰ或Ⅱ级,拟在超声引导下行腋路臂丛神经阻滞.采用随机数字表法,将其分为2组(n=26),对照组(C组)神经阻滞时仅用罗哌卡因;右美托咪定组(D组)神经阻滞时局部注射罗哌卡因和0.8 μg/kg右美托咪定的混合液.以臂丛支配区痛觉消失为阻滞有效,局麻药容量30 ml,采用序贯法确定罗哌卡因浓度:初始浓度为0.50％,相邻浓度比值为1.2,阻滞有效则下一例采用低一级浓度,阻滞无效则下一例采用高一级浓度.用Dixon-Massey法确定EC50及其95％可信区间.结果 D组罗哌卡因EC50(95％可信区间)为0.32％ (0.30％ ～ 0.33％),C组为0.44％ (0.42％ ～ 0.46％).D组罗哌卡因EC50低于C组(P＜0.05).结论 右美托咪定局部用药可降低罗哌卡因臂丛神经阻滞的EC50,提示其具有局麻药样效应.     

复合右美托咪定时瑞芬太尼抑制甲状腺手术患者无肌松气管插管反应的量效关系

目的:确定复合右美托咪定时瑞芬太尼抑制甲状腺手术患者无肌松气管插管反应的半数有效剂量(ED 50)和95%有效剂量(ED 95)。 方法:择期行术中神经监测下甲状腺手术患者,性别不限,年龄18～64岁,ASA分级Ⅰ或Ⅱ级,体重指数18～28 kg/m 2。麻醉诱导前10 m...     

不同剂量右美托咪啶对下腹部手术患者七氟醚MACBAR的影响

目的 评价不同剂量右美托咪啶对七氟醚抑制50%下腹部手术患者切皮诱发应激反应的最低肺泡气有效浓度(MACBAR)的影响.方法 择期全麻下拟行下腹部手术患者60例,年龄25～55岁,体重45～75 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患者随机分为对照组(D0组,n=15)和不同剂量右美托咪啶组(D1～3组,n=15).D0组不使用右美托咪啶,D1-3组经10 min静脉注射右美托咪啶0.1 μg/kg负荷剂量后,分别以0.4、0.8、1.2μg·kg-1·h-1的速率静脉输注30 min后进行麻醉诱导.D0-3组第1例患者呼气末七氟醚浓度分别为3.0%、2.5%、2.0%、1.5%,以切皮时患者MAP或HR较基础值上升＜15%为抑制交感肾上腺反应有效,若抑制交感肾上腺反应有效则下一例呼气末七氟醚浓度降低一级,若无效则升高一级,相邻浓度比为0.9.计算七氟醚MACBAR及其95%可信区间(95%CI).结果 D0～3组七氟醚MACBAR及其95%CI分别为:2.85%(2.44%～3.32%)、1.9l%(1.6l%～2.26%)、1.52%(1.3l%～1.77%)、1.34%(1.15%～1.57%).与D0组比较,D1-3组七氟醚MACBAR均降低(P＜0.05);与D1组比较,D2组和D3组七氟醚MACBAR降低(P＜0.05);D2组和D3组七氟醚MACBAR比较差异无统计学意义(P＞0.05).结论 右美托咪啶0.4、0.8和1.2μg·kg-1·h-1连续输注30 min可降低七氟醚MACBAR,增强七氟醚抑制应激反应的效应,且呈剂量依赖性.

Abstract：

Objective To investigate the effects of different doses of dexmedetomidine on the minimum alveolar concentration of sevoflurane for blunting responses to skin incision ( MACBAR ) in patients undergoing lower abdominal surgery. Methods Sixty ASA Ⅰ or Ⅱ patients, aged 25-55 yr, weighing 45-75 kg, undergoing electire lower abdominal surgery under general anesthesia, were randomly divided into 4 groups ( n = 15 each): control group (Do group) and 3 dexmedetomidine groups (D1, D2 and D3 groups). The patients were unpremedicated.Dexmedetomidine was not used in group D0. A loading dose of dexmedetomidine 0.1μg/kg was injected iv over 10 min, and then dexmedetomidine was infused at a rate of 0.4, 0.8 and 1.2 μg· kg- 1 · h - 1 for 30 min in groups D1-3 respectively. Anesthesia was induced with inhalation of 8 % sevoflurane. Laryngeal mask airway was inserted when BIS value decreased to 45-55. The patients were mechanically ventilated with inhalation of sevoflurane and a mixture of 50% nitrous oxide and 50% oxygen, and the fresh gas flow was set at 1 L/min. In D0-3 groups, the initial end-tidal concentrations of sevoflurane were 3.0%, 2.5%, 2.0% and 1.5% respectively. The patients' response to skin incision was described as effective if MR or MAP increased by ＜ 15%, or ineffective (MR or MAP increased by ≥ 15%). When the response was effective, the end-tidal concentration of sevoflurane was decreased in the next patient, when ineffective, increased, and the ratio between the two successive concentrations was 0.9.The MRCBAR of sevoflurane was determined by up-and-down method, and 95% confidence interval was calculated.Results The MRCBAR (95% confidence interval) of sevoflurane was 2.85% (2.44%-3.32%), 1.91%(1.61%-2.26%), 1.52% (1.31%-1.77%), and 1.34% (1.15%-1.57%)in D0-3 groups respectively. The MRCBAR of sevoflurane was significantly lower in D1-3 groups than in D0 group, and in D2 and D3 groups than in group D1 (P ＜0.05＝. There was no significant difference in MRCBAR of sevoflurane between D2 and D3 groups (P ＞0.05) .Conclusion Continuous infusion of dexmedetomidine at 0.4, 0.8 and 1.2 μg·kg-1 ·h-1 for 30 min results in a decrease in MACBAR of sevoflurane and enhances the inhibitory effect of sevoflurane on the stress response, and in a dose-dependent manner.     

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

目的 探讨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(EC50)的影响.方法 择期拟在全身麻醉下行妇科手术患者80例,ASA 分级Ⅰ或Ⅱ级,年龄18～64岁,采用随机数字表法,将患者随机分为4组(n=20):R0组不使用瑞芬太尼;R1～3组瑞芬太尼效应室靶浓度分别为1、2、3ng/ml.麻醉诱导开始时先靶控输注瑞芬太尼,达设定效应室靶浓度后,再以血浆靶浓度0.6μg/ml为起点开始靶控输注依托咪酯,此后每分钟增加依托咪酯的血浆靶浓度0.1 μg/ml直至患者意识消失及对伤害性刺激诱发体动反应消失.记录患者意识消失及对伤害性刺激诱发体动反应消失时依托咪酯的效应室靶浓度,采用Probit法计算EC50.结果 随瑞芬太尼效应室靶浓度升高,患者意识消失时和伤害性刺激诱发体动反应消失时依托咪酯的EC50逐渐降低(P<0.05).结论 靶控输注1、2.3 ng/ml的瑞芬太尼可呈浓度依赖性地强化依托咪酯的镇静镇痛作用.

Abstract：

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.     

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.     

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.     

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.