瑞芬太尼对高血压患者地氟醚交感兴奋作用的半数有效浓度  

Determination of the EC_(50) for Remifentanil Blocking the Sympathetic Activation Induced by Desflurane in Essential Hypertensive Patients

作　　者：曾静贤[1] 苗利萍[1] 李杰[1] 夏淑轩[1] 

机构地区：[1]中山大学附属第二医院麻醉科,广东省广州市510120

出　　处：《中国动脉硬化杂志》2009年第6期470-472,共3页Chinese Journal of Arteriosclerosis

摘　　要：目的测定瑞芬太尼抑制高血压患者快速吸入地氟醚后交感兴奋的半数有效浓度。方法选择30例高血压患者,在麻醉诱导下行气管插管,气管插管成功后开启地氟醚使呼气末浓度达到0.5 MAC并持续20min。根据序贯试验的方法,血浆靶控输注瑞芬太尼,初始浓度为4μg/L,再快速提高地氟醚的吸入浓度达1.5 MAC。在快速吸入地氟醚前后3 min,每30 s测量一次血压和心率,分别取平均值。当吸入前后的血压和心率变化率同时大于15%为交感兴奋,下一患者瑞芬太尼的量下降一阶梯,反之升高一阶梯。结果共5例高血压患者因结果可疑而被排除,余25例呈有效或无效而进入分析。瑞芬太尼抑制高血患者地氟醚交感兴奋作用的半数有效浓度为2.09μg/L,其95%可信区间是2.08μg/L～2.10μg/L。结论利用序贯试验方法测定血浆靶控瑞芬太尼抑制高血压患者快速吸入地氟醚后引起交感兴奋的半数有效浓度为2.09μg/L。Aim To determine the effective concentration of remifentanil in 50% essential hypertensive patients （EC50 ） for blocking the sympathetic activation induced by desflurane. Methods Thirty essential hypertensive patients scheduled for elective surgery were enrolled in the study. The patients were inspired with desflurane 0.5 MAC after endotracheal intubation. Twenty minutes later, the first dose of remifentanil 4 μg/L which was determined by up and down sequential experiment was given by target plasma concentration（TCI）. Both the blood perssure （BP） and heart rate （ HR ） were recorded and averaged every 30 seconds of 3 minutes before or after fast inducting desflurane 1.5 MAC. If both the rate of average BP and average HR were increase 15% the next patient received remffentanil of a lower concentration; if both the rate of average BP and average HR were descrease 15% the concentration of remifentanil was increased in the next patients. Result Among the 30 essential hypertensive patients, five were excluded from the study because of uncertain efficacy. The results showed that the EC50 of remifentanil blocking the sympathetic activation induced by desilurane was 2.09 μg/L （ 95 % CI was 2.08μg/L -2.10 μg/L）. Conclusions The EC50 of remifentanil given by TCI which blocked the sympathetic activation induced by desflurane in essential hypertensive was 2.09μg/L determined by sequential experiment method.

关 键 词：地氟醚 交感神经 高血压 

分 类 号：R96[医药卫生—药理学]