复合靶控输注异丙酚时瑞芬太尼抑制重症肌无力患者气管插管反应的药效学  

Pharmacodynamics of remifentanil blunting responses to tracheal intubation performed under propofol anesthesia administered by TCI in patients with myasthenia gravis

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

机构地区：[1]卫生部北京医院麻醉科,100730

出　　处：《中华麻醉学杂志》2009年第2期118-120,共3页Chinese Journal of Anesthesiology

摘　　要：目的探讨复合靶控输注异丙酚时瑞芬太尼抑制重症肌无力患者气管插管反应的药效学。方法拟行经胸骨正中劈开胸腺切除术的重症肌无力患者45例，ASAⅠ或Ⅱ级，TCI异丙酚和瑞芬太尼进行麻醉诱导，异丙酚血浆靶浓度为4μg／ml，瑞芬太尼初始效应室靶浓度（Ce）为1.8ng／ml，依次按2．7、4．0、6．0ng／ml梯度递增，至患者可耐受喉麻管置人声门下进行气管内表麻后，进行气管插管。采用概率单位回归分析法分别计算瑞芬太尼抑制气管插管反应的Ce50和Ce95。结果瑞芬太尼抑制气管插管反应的Ce50为2．2ng／ml，其95％可信区间为2．0～2．3ng／ml；抑制气管插管反应的Ce95为3．0ng／ml，其95％可信区间为2．8～3．5ng／ml。结论复合靶控输注异内酚（血浆靶浓度为4μg／ml）时，瑞芬太尼抑制重症肌无力患者气管插管反应的Ce50和Ce95分别为2．2、3．0ng／ml。Objective To investigate the pharmacodynamics of remifentanil blunting the responses to tracheal intubation performed under propofol anesthesia in patients with myasthenia gravis. Methods Forty-five ASA Ⅰ or Ⅱ patients with myasthenia gravis aged 18-64 yr weighing 45-95 kg scheduled for traMs-sternal thymectomy were enrolled in this study. ECG, BP, HR, SpO2 and BIS were monitored. Anesthesia was induced with propofol and remifentanil both administered by TCI. The target plasma concentration （Cp） of propofol was set at 4 μg/ml during induction. The initial target effect-site concentration （Ce） of remifentanil was set at 1.8 ng/ml and was increased step bY step to 2.7, 4.0 and 6.0 ng/ml until the patients could tolerate laryngoscopy and insertion of larynx anesthetic tube into subglottic space without body movement, coughing or bucking. Topical anesthesia of trachea was then performed by spraying 2 % lidocaine 2 ml through the larynx anesthetic tube. Laryngoscope and larynx anesthetic tube were removed and the patients were ventilated with O2 through anesthetic mask for 1-2 min before tracheal intubation. The Ce50 and Ce95 （95 % confidence interval） were calculated by Probit analysis. Results The Ce50 and Ce95 of remifentanil blunting responses to tracheal intubation performed with propofol administered by TCI was 2.2 ng/ml （95% CI 2.0-2.3 ng/ml） and 3.0 ng/ml （95% CI 2.8-3.5 ng/ml） respectively. Conclusion The Ce50 and Ce95 of remifentanil blunting responses to tracheal intubation performed under propofol anesthesia are 2.2 and 3.0 ng/ml respectively.

关 键 词：哌啶类 剂量效应关系 药物 二异丙酚 药物释放系统 插管法 气管内 重症肌无力 

分 类 号：R614[医药卫生—麻醉学] R746.1[医药卫生—外科学]