异丙酚麻醉下瑞芬太尼抑制不同年龄老年患者气管插管和切皮反应的半数有效血浆靶浓度  

Half-effective target plasma concentration of remifentanil blunting cardiovascular responses to tracheal intubation and skin incision during propofol anesthesia in elderly patients of different ages

作　　者：赵丽艳[1] 谢红[1] 李华[1] 王琛[1] 周迅[1] 徐府奇[1] 

机构地区：[1]苏州大学附属第二医院麻醉科,215004

出　　处：《中华麻醉学杂志》2008年第10期877-880,共4页Chinese Journal of Anesthesiology

摘　　要：目的确定异丙酚麻醉下瑞芬太尼抑制不同年龄老年患者气管插管和切皮反应的半数有效血浆靶浓度（EC50）。方法择期全麻老年患者116例，年龄60．79岁，体重39～82kg，ASAⅠ-Ⅲ级，按年龄及刺激不同分为4组，靶控输注异丙酚，待患者意识消失时靶控输注瑞芬太尼，Ⅰ-TI组（60-69岁，n=33）和Ⅱ-TI组（70-79岁，n=31）第1例患者瑞芬太尼初始血浆靶浓度设为3．5ng／ml，待效应室浓度与血浆靶浓度达平衡后静脉注射维库溴铵0．1mg／kg，3min后行气管插管。Ⅰ-SI组（60～69岁，n=26）和Ⅱ-SI组（70～79岁，n=26）第1例患者气管插管后瑞芬太尼初始血浆靶浓度设为2．5ng／ml，待效应室浓度与血浆靶浓度达平衡后维持10min，开始切皮，采用改良序贯法进行试验。发生心血管反应的标准：气管插管或切皮后3min内平均动脉压或心率较气管插管或切皮前的基础值升高超过20％。计算各组EC50及其95％可信区间（CI）。结果Ⅰ-TI组和Ⅱ-TI组瑞芬太尼抑制气管插管反应的EC50及其95％CI分别为2．90（2．76～3．04）ng／ml和3．16（2．90～3．41）ng／ml，差异无统计学意义（P〉0．05）；Ⅰ-SI组和Ⅱ-SI组瑞芬太尼抑制切皮反应的EC50及95％CI分别为1．90（1．76～2．04）ng／ml和1．77（1．68～1．85）ng／ml，差异无统计学意义（P〉0．05）；与Ⅰ-TI组比较，Ⅰ-SI组EC50降低（P〈0．05）；与Ⅱ-TI组比较，Ⅱ-SI组EC50降低（P〈0．05）。结论60～69岁患者靶控输注异丙酚至意识消失时瑞芬太尼抑制气管插管和切皮反应的EC50分别为2．90、1．90ng／ml，70～79岁患者分别为3．16、1．77ng／ml，不随年龄增加而改变。Objective To determine the half-effective target plasma concentration of remifentanil TCI （EC50） blunting sympathetic responses to tracheal intubation （TI） and skin incision （SI） during propofol anesthesia in elderly patients of different ages. Methods One hundred and sixteen ASA Ⅰ-Ⅲ patients aged 60-79 yr weighing 39-82 kg undergoing elective surgery under general anesthesia were divided into 4 groups： group TI1 （60- 69 yr, n = 33） ; group TI2 （70-79 yr, n = 31） ; group SI1 （60-69 yr, n = 26） and group SI2 （70-79 yr, n = 26）. EC50 was determined by modified Dixon＇s up-and-down method. The cardiovascular response was defined as positive when MAP or HR increased by 20 % of the baseline value within 3 min after tracheal intubation or skin incision. Each time the target plasma concentration （CT） increased/decreased by 0.5 ng/ml. The increment/ decrement was reduced to 0.2 ng/ml after 3 up-and-down experiments. Anesthesia was induced with propofol TCI. As soon as the patients lost conciousness, TCI of remifentanil was started. The initial CT of remifentanil was 3.5 ng/ml. Tracheal intubation was facilitated with vecuronium 0.1 mg/kg at 3 min after the target effect-site and plasma concentrations were balanced. In group SI1 and SI2 the initial CT of remifentanil was 2.5 ng/ml. Skin incision was made at 10 min after the target effect-site concentration was balanced with plasma concentration with BIS maintained at 50-60. EC50 and 95 % confidence interval （CI） were determined. Results The EC50 （95 % CI） for patients in group TI1, TI2 and SI1, SI2 was 2.90 （2.76-3.04） ng/ml, 3.16 （2.90-3.41） ng/ml and 1.90 （1.76-2.04） ng/ml, 1.77 （1.68-1.85）ng/ml respectively. There was no significant difference between the 2 age groups. The EC50 of remifentanil required to prevent response to skin incision in 50% of patients was significantly smaller than that required to prevent intubation response during propofol anesthesia. Conclusion The EC50 of remifentanil blunting car

关 键 词：哌啶类 二异丙酚 剂量效应关系 药物 药物释放系统 老年人 

分 类 号：R614[医药卫生—麻醉学] R169.42[医药卫生—外科学]