瑞芬太尼抑制纤支镜辅助经鼻气管插管反应的半数有效效应室浓度测定

目的测定瑞芬太尼抑制纤支镜辅助经鼻气管插管反应的半数有效效应室浓度（ECe50）。方法将ASAI级、择期全麻下行脊柱手术的30～60岁患者，按性别分为男性与女性组，每组20例。采用丙泊酚和瑞芬太尼联合效应室静脉靶控麻醉。所有患者在入室开通静脉并鼻黏膜充分表面麻醉后，静脉以丙泊酚效应室2mg·L^-1靶浓度镇静，在丙泊酚的血浆-效应室浓度达平衡后开始按Dixon序贯法输注瑞芬太尼。每例患者在瑞芬太尼血浆-效应室靶浓度达平衡后3mim开始经鼻将纤支镜送入声门，然后通过纤支镜引导置入气管导管，观察患者插管反应。当纤支镜进入气管内出现呛咳、插气管导管过程中多次呛咳或伴憋气及呼吸困难或烦躁不安、手足乱动均视为插管反应阳性。结果男性患者和女性患者的瑞芬太尼E（冯D分别为4．1ug·L^-1（95％可信区间3．80—4．39ug·L^-1）和3．7ug·L^-1（95％可信区间3．48—3．97ug·L^-1）（P〈0．01）。结论瑞芬太尼可抑制纤气镜辅助经鼻气管插管反应，且抑制插管反应的ECe50存在性别差异。

ECe50 of remifentanil in target effect-site concentration inhibiting nasotracheal intubation response with fiberbronchoscope

AIM To determine the ECes0 of remifentanil in target effect-site concentration inhibiting nasotracheal intubation response with fiberbronchoscope. METHODS Forty ASA 1 patients of male（ n = 20, aged 30 - 60 years） and female （ n = 20, aged 30 - 60 years） scheduled for spinal operation. Intravenous anesthesia was give by targeting effect-site concertration of pmpofol combined with targeting effect-site concertration of remifentanil. The vein was piqured and the head was put in the natural posture for all patients. The nostril through which the patient＇s breathing was most easily was selected in advance and prepared. Every patient was mitigated with pmpofol by target control infusion（TCI） at target effect-site concentration 2 mg·L^-1 at the same time. Remifentanil was infused by TCI at target effect-site concentration after the target concentration of plasma and effect-site of propofol was balanced. The target effect-site concentration of remifentanil was determined according to Dixon＇s up-and-down method. The the bronchoscope was put into the trachea slowly after the target concentration of plasma and effect-site of remifentanil was balanced. Finally , the endotracheal tube was slipped over the bronchoscope and was inserted into trachea. Proper endotracheal tube position was confirmed by viewing the tip of the tube above the carina before the fiberoptic scope was withdrawn, and the response to tracheal intubation was observed during tracheal intubation. When the bronchoscope was put into the trachea, any bucking was considered positive. When the endotracheal tube was inserted into trachea, any breath holding or dyspnoea or any gross movement of extremity the response was considered positive. RESULTS The ECe50 of remifentanil was 4.1 ug·L^-1,3.7ug·L^-1, respectively （ P 〈 0.01） and the 95 % confidence interval was 3.80 - 4.39 ug·L^-1,3.48 - 3.97ug·L^-1, respectively in male group and female group. CONCLUSION It is effective to block the endotracheal tube response with remifentanil by TCI a