靶控输注丙泊酚诱导重症肌无力患者气管插管所需舒芬太尼的半数有效浓度  

Effective target site concentration of sufentanil required by tracheal intubation with response of 50% myasthenia gravis(MG) patients anesthetized with propofol by target controlled infusion(TCI)

作　　者：石妤[1] 左明章[1] 闫春伶[1] 孟小燕[1] 杨宁[1] 

机构地区：[1]卫生部北京医院麻醉科,北京100730

出　　处：《中国医刊》2008年第5期34-36,共3页Chinese Journal of Medicine

摘　　要：目的研究靶控输注（TCI）丙泊酚和舒芬太尼复合气管内表面麻醉,在无肌肉松弛药物作用下诱导重症肌无力患者气管插管所需的半数有效浓度。方法拟行经胸骨正中劈开胸腺切除术的重症肌无力患者20例,ASAⅠ或Ⅱ级（Ⅰ型3例;Ⅱa型4例;Ⅱb型10例;Ⅲ型1例;Ⅳ型2例;Ⅴ型0例）。麻醉诱导丙泊酚采用血浆浓度（Cp）靶控输注,维持4μg/ml不变;舒芬太尼采用效应室浓度（Ce）靶控输注,按序贯法确定浓度,依次为0.10、0.15、0.23、0.34、0.5ng/ml等比递增,相邻效应室靶浓度之间比例为1.5。复合气管内表面麻醉后行气管插管。监测诱导、插管过程中的血压、心率和脑电双频指数（BIS）。结果50%患者完成插管时舒芬太尼的浓度为0.22ng/ml,95%的可信区间为0.17～0.28 ng/ml。结论在不使用肌肉松弛药和复合气管内表面麻醉的情况下完成气管插管,丙泊酚血浆靶浓度为4μg/ml时,舒芬太尼半数有效效应室靶浓度为0.22ng/ml。Objective To determine the effect site concentration of sufentanil based on the Target Controlled Infusion（TCI） of propofol-sufentanil and the endotrachea surface anesthesia to induce tracheal intubation response in 50% of myasthenia gravis（MG） patients（Ce50） anesthetized without muscle relaxant.Methods Twenty ASA ⅠorⅡ MG patients undergoing thymectomy（Ⅰ type 3 people;Ⅱa type 4 people;Ⅱb type 10 people;Ⅲ type 1 people;Ⅳ type 2 people;V type 0 people）were enrolled.Anesthesia was induced with both propofol and sufentanil given by TCI.The target plasma site concentration of propofol was set at 4μg/ml throughout induction,and the different target effect site concentration of sufentanil was set 0.10 ng/ml,0.15ng/ml,0.23 ng/ml,0.34 ng/ml,0.5ng/ml respectively.The Ce50 was determined by up and down sequential trial.The ratio of two consecutive target site concentration was 1.5.The topical anesthesia of endotrachea combined with intubation.BP,HR and bispectral index（BIS） were monitored during induction and intubation.Results The Ce50 of sufentanil Ce for intubation was 0.22ng/ml.The 95% confidence interval was 0.17～0.28 ng/ml.Conclusion The Ce50 of sufentanil at target plasma site concentration of propofol of 4μg/ml is 0.22ng/ml when the topical anesthesia of endotrachea conducts while intubating without muscle relaxant.

关 键 词：丙泊酚 舒芬太尼 药物释放系统 重症肌无力 剂量效应关系 药物 

分 类 号：R746.1[医药卫生—神经病学与精神病学]