瑞芬太尼靶控输注抑制气管拔管期循环反应半数有效浓度的测定-现代医学

瑞芬太尼靶控输注抑制气管拔管期循环反应半数有效浓度的测定

作者：许梅唐伟

单位：中国医学科学院肿瘤医院深圳医院麻醉科, 广东深圳 518116

分类号：R971.2

出版年·卷·期（页码）：2017·36·第十一期（1646-1649）

摘要：

目的：探讨瑞芬太尼联合丙泊酚全凭静脉麻醉时抑制50%患者气管拔管期循环反应的瑞芬太尼靶控输注（TCI）半数有效浓度（EC₅₀），以指导临床麻醉。方法：纳入2016年6月至2017年6月于本院接受非心脏手术的30例全麻患者，美国麻醉医师协会（ASA）分级均为Ⅰ～Ⅱ级。所有患者均在脑电双频指数（BIS）监控下开展瑞芬太尼联合丙泊酚全凭静脉麻醉诱导，手术结束缝皮时停用丙泊酚，并将瑞芬太尼调整至试验浓度。根据上下序贯法原则设定瑞芬太尼试验浓度：第1例患者瑞芬太尼血浆靶质量浓度2 ng·ml^-1，间隔质量浓度为0.2 ng·ml^-1。记录患者麻醉诱导前（T₁），拔管期瑞芬太尼达到试验浓度时（T₂），拔管即刻（T₃），拔管后1 min（T₄）、2 min（T₅）、3 min（T₆）、4 min（T₇）、5 min（T₈）时患者平均动脉压（MAP）、心率（HR）。结果：所有手术均在患者接受单次肌松药下成功完成，手术时间均在2 h内，术中未见严重应激反应、心动过缓及低血压等不良事件发生，术后未见皮肤瘙痒、疼痛、恶心呕吐等并发症，拔管时6例患者出现呛咳。根据序贯法，瑞芬太尼抑制拔管期循环反应的EC₅₀为1.637 ng·ml^-1，其95%CI为1.481～1.769 ng·ml^-1。结论：瑞芬太尼联合丙泊酚全凭静脉麻醉时，抑制50%患者气管拔管期循环反应的瑞芬太尼TCI血浆靶质量浓度为1.637 ng·ml^-1。

Objective:To investigate half effective concentration of remifentanil for inhibiting 50% patients from circulatory response(EC₅₀) during extubation under total intravenous anesthesia, in order to guide clinical anesthesia. Methods:Thirtynon cardiac surgery patients under general anesthesia from June 2016 to June 2017 in our hospital, whose ASA classification was Ⅰ-Ⅱ were included. All patients were induced anaesthetized by remifentanil combined with propofol under the control of BIS.Propofol was discontinued at the end of the operation, and remifentanil was adjusted to the preset concentration. According to up-and-down method, the concentration of remifentanil was adjusted:target plasma concentration of remifentanil in the first patients was 2 ng·ml^-1, the interval concentration was 0.2 ng·ml^-1. MAP and HR of patients were recorded before induction of anesthesia(T₁), at the time remifentanil reached preset concentration before extubation(T₂), just after extubation (T₃), 1 min(T₄), 2 min(T₅), 3 min(T₆), 4 min(T₇),5 min(T₈) after extubation was detected. Results:All the procedures wentsuccessfully and all patients received a single dose of muscle relaxant.The operation time was less than 2 h. No stress response, severe bradycardia, hypotension and other adverse events during operation, no skin itching, pain, nausea and vomiting and other complications after extubation were seen. 6 cases of patients coughed after extubation.According to the up-and-down method, EC₅₀ of remifentanil for inhibiting circulatory response was 1.637 ng·ml^-1, 95%CI=1.481-1.769 ng·ml^-1. Conclusion:In remifentanil combined with propofol for intravenous anesthesia, the concentration of remifentanil for inhibiting 50% patients from circulatory response during extubation is 1.637 ng·ml^-1.

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