瑞芬太尼麻醉下丙泊酚抑制老年患者胃镜插入时体动ED50的临床观察

目的：测定不同剂量瑞芬太尼麻醉下丙泊酚抑制老年患者胃镜插入时体动的半数有效剂量（ED50）。方法选择2013年10月至2014年5月90例在南京鼓楼医院自愿接受无痛胃镜检查的90例老年患者为研究对象，按照静脉滴注瑞芬太尼的剂量随机分为三组，每组30例，A组0．15μg／kg、B组0．30μg／kg、C组0．45μg／kg，依次缓慢推注丙泊酚和瑞芬太尼，以胃镜插入时有无体动或呛咳为指标，采用序贯法测定各组丙泊酚抑制胃镜插入时体动的ED50和95％可信区间。结果A、B、C三组丙泊酚抑制胃镜插入时体动的ED50分别为0．80、0．69、0．57mg／kg，95％可信区间分别为（0．72～0．88）mg／kg、（0．60～0．78）mg／kg、（0．52～0．62）mg／kg。结论老年患者无痛胃镜麻醉诱导时，丙泊酚和瑞芬太尼呈协同作用，瑞芬太尼能减少丙泊酚抑制胃镜插入时体动的ED50。

Detection the median effective dose of propofol under remifentanil intravenous anesthesia for preventing body movement during gastroscope insertion of elderly patients

Objective To detection the median effective dose （ED50）of propofol under remifentanil intrave‐nous anesthesia for preventing body movement during gastroscope insertion of elderly patients .Methods Ninety eld‐erly patients undergoing painless gastroscopy were randomly divided into three groups ,each group with thirty cases .The remifentanil intravenous doses of the three groups were 0 .15μg /kg （group A）、0 .30 μg/kg （group B） and 0 .45 μg/kg （group C）respectively .The dose of propofol was adjusted according to the patient＇s reaction using an up‐and‐down method .Using sequential design ,the ED50 of propofol was determined .Results The ED50 of propofol were 0 .80 mg/kg95% confidence interval（CI）：0 .72-0 .88 mg/kg]in group A ,0 .69 mg /kg（95% CI：0 .60-0 .78 mg/kg）in group B ,0 .57 mg/kg （95% CI：0 .52 -0 .62 mg/kg ）in group C .Conclusion For anesthesia induction of painless gastroscopy ,the pharmacodynamic interaction between remifentanil and propofol was synergism ,remifentanil could decrease the ED50 of propofol to prevent the body movement response to gastroscope insertion .