依托咪酯与雷米芬太尼在全身麻醉诱导时的相互作用  

A study on the interactions between etomidate and remifentanil in anesthesia induction

作　　者：赵茗姝[1,2] 王国林[1] 于泳浩[1] 高宝柱[2] 

机构地区：[1]天津医科大学总医院麻醉科,300070 [2]天津市第三中心医院麻醉科

出　　处：《临床麻醉学杂志》2010年第7期569-572,共4页Journal of Clinical Anesthesiology

摘　　要：目的用等辐射分析法研究全身麻醉诱导时依托咪酯、雷米芬太尼之间的相互作用。方法择期腹部手术患者75例随机均分为依托咪酯组(E组)、雷米芬太尼组(R组)和复合组(ER组)。各组再分成5个亚组(E1～E5、R1～R5、ER1～ER5组)。麻醉诱导前给药,E1～E5组分别给予依托咪酯0.040、0.060、0.085、0.115、0.155 mg/kg,R1～R5组分别给予雷米芬太尼5.400、7.105、8.850、11.200、15.540μg/kg,ER1～ER5组分别给予依托咪酯及雷米芬太尼0.021 mg/kg+2.600μg/kg、0.030 mg/kg+3.500μg/kg、0.045 mg/kg+4.200μg/kg、0.060 mg/kg+5.500μg/kg、0.080 mg/kg+7.600μg/kg。监测给药前(T1)及给药后1min(T2)、2min(T3)、3min(T4)、5 min(T5)的SBP、DBP、HR、SpO2、听觉诱发电位指数(AAI)的变化。口令法判断患者是否进入催眠状态。点斜法计算各自药物催眠末点的半数有效量(ED50)及复合后两种药物的ED50,以等辐射分析法分析两药在催眠末点的相互作用。结果在催眠末点,依托咪酯ED50为0.084 mg/kg(95%可信限0.070～0.103μg/kg);雷米芬太尼ED50为8.100μg/kg(95%可信限7.901～8.435μg/kg);ER组依托咪酯和雷米芬太尼ED50分别为0.038 mg/kg和3.900μg/kg(95%可信限0.032～0.043μg/kg和3.760～4.200μg/kg)。两药在催眠作用上呈现相加。E1～E5组、R1～R5组、ER1～ER5组给药前后血流动力学变化无统计学意义。E4、ER4组T3、T4时、E5组T2、T3时、ER5组T2～T4时AAI显著低于T1时(P<0.05)。结论依托咪酯、雷米芬太尼两药在催眠作用上呈现相加,复合用药血流动力学稳定。Objective To investigate the interactions between etomidate and remifentanil on the hypnosis using isobolographic analysis. Methods Seventy five patients scheduled for abdominal operations were randomly assigned into three groups of E, R and ER, and each group was further divided into five subgroups of E1-E5, R1- R5, ER1-ER5. Different doses of etomidate or remifentanil or their conbinations were injected before induction. BP, HR, SpO2 auditory evoked potentials index （AAI） and consciousness at five time points were recorded. Median effective dose （ED50） was calculated. Isobolographic analysis was performed to discribe the interactions of etomidate and remifentanil. Results At the hypnotic endpoints, the ED50 of etomidate was 0. 084 mg/kg（95% CI 0. 070-0. 103μg/kg） ,ED50 of remifentanil was 8. 100 μg/kg（95% CI 7. 901-8. 435 μg/kg）,and ED50 of etomidate was 0. 038 mg/kg and ED50 of remifentanil was 3. 900 g/kg（95% CI 0. 032 0. 043μg/kg/ 3. 760-4. 200 μg/kg） in group ER. At the hypnotic endpoints, the interaction of etomidate and remifentanil showed additive effect. In group E4 and E5, AAI were decreased significantly after administration at T2, T3 and T1, T2 compared with those before. In group ER4 and ER5, AAI was decreased significantly at T2, T3 and T1 , T2,T3 compared with those before induction（P〈0. 05）. Conclusion The interaction of etomidate and remifentanil shows additive effect. In terms of hemodynamics stability, ER etomidate combined with remifentanil is better than etomidate or remifentanil alone.

关 键 词：药物相互作用 依托咪酯 雷米芬太尼 

分 类 号：R614[医药卫生—麻醉学]