腰硬联合麻醉下异丙酚镇静的剂量效应特征及可行性研究  

The pharmacodynamics of propofol target-controlled infusion for sedation undergoing spinal epidural combined anesthesia

作　　者：陈勇[1] 佘守章[2] 闫焱[2] 

机构地区：[1]海南省人民医院麻醉科,海口570311 [2]广州医学院附属市一人民医院麻醉科,广州510180

出　　处：《广东医学》2005年第6期733-735,共3页Guangdong Medical Journal

基　　金：广东省医学科学研究基金资助项目(A2002573)

摘　　要：目的探讨定腰麻-硬膜外联合麻醉下丙泊酚靶控输注(TCI)镇静的药效学特征及丙泊酚血浆靶浓度和镇静深度半数有效量的测定。方法选择43例择期腰麻-硬膜外联合麻醉下行下腹部及下肢手术患者(ASAⅠ级),腰麻阻滞完善后,丙泊酚TCI镇静,靶控血药浓度最初设定为0.5μg/ml,以患者OAA/S平分为镇静指标,计算不同镇静深度(OAA/S评分)的半数有效EC(EC50)、半数有效BIS(BIS50)、半数有效AAI(AAI50),并观察对循环和呼吸的变化。结果患者OAA/S4分时丙泊酚EC50、BIS50和AAI50分别为0.57μg/ml、89和73,OAA/S3分时丙泊酚EC50、BIS50和AAI50分别为1.01μg/ml、75和61,OAA/S2分时丙泊酚EC50、BIS50和AAI50分别为1.31μg/ml、67和43;丙泊酚靶控输注镇静不同深度对循环和呼吸影响没有显著差异性。结论EC50、BIS50和AAI50的测定为国人腰硬联合麻醉下丙泊酚TCI镇静提供了浓度和药效学数据,腰硬联合麻醉下丙泊酚TCI镇静是安全可行的。Objective To measure the effective concentration at which 50% of patients loss response to the OAA/S level(EC_(50)), BIS_(50) and AAI_(50) of propofol target-controlled infusion for sedation relation to different OAA/S during spinal-epidural combined anesthesia. Methods Forty-three patients, ASA Ⅰ, aged 16～60 yrs, were scheduled for lower abdominal or lower limb surgery under went spinal epidural combined anesthesia. After ensuring an adequate level of the local blockage, patients were sedated with i.v. propofol delivered by a Diprifusor target-controlled infusion(TCI). Bispectral index(BIS) and auditory evoked potential index(AAI) were measured and effect-site propofol concentrations(EC) were predicted. Values of EC_(50), BIS_(50) and AAI_(50) at the clinical end-points of OAA/S score were calculated. The changes in circulation and SpO_2 were recorded. Results At the clinical end-point of OAA/S score 4,the EC_(50),BIS_(50) and AAI_(50) were 0.57 (μg/ml), 85 and 72 respectively. At the clinical end-point of OAA/S score 3, the EC_(50),BIS_(50) and AAI_(50) were 1.01 (μg/ml), 75 and 61 respectively. At the clinical end-point of OAA/S score 2, the EC_(50),BIS_(50) and AAI_(50) were 1.31 (μg/ml), 67 and 43 respectively. There were no significant changes in the HR, MAP and SpO_2 sedation. Conclusion The EC_(50), BIS_(50) and AAI_(50) provide an important performance value for the propofol sedations during spinal-epidural combined block. The sedation with propofol TCI is a safe and feasible.

关 键 词：腰硬联合麻醉 异丙酚镇静 腰麻-硬膜外联合麻醉 剂量效应 BIS50 OAA/S评分 EC50 靶控输注镇静 丙泊酚 镇静深度 半数有效量 药效学特征 TCI 手术患者 方法选择 血药浓度 呼吸影响 不同深度 ml 靶浓度 下腹部 差异性 测定 

分 类 号：R614.4[医药卫生—麻醉学] R614[医药卫生—外科学]