小儿中阿片类药物对丙泊酚镇静药效学的影响  

Influence of opioids on propofol pharmacodynamics during anesthesia induction in pediatric patients

作　　者：黄悦[1] 白洁[1] 杭燕南[2] 张马忠[1] 陈煜[1] 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心麻醉科,200127 [2]上海交通大学医学院附属仁济医院麻醉科

出　　处：《上海医学》2010年第10期912-914,共3页Shanghai Medical Journal

摘　　要：目的基于小儿麻醉诱导期脑电双频指数(BIS)及丙泊酚效应室质量浓度的变化,定量分析阿片类药物对丙泊酚镇静药效学的影响。方法将45例不用术前药的患儿随机分为3组:C组静脉输注0.9%氯化钠溶液,R组静脉输注瑞芬太尼0.3μg.kg-1.min-1,S组静脉输注舒芬太尼0.02μg.kg-1.min-1。30min后开始丙泊酚靶控输注,起始效应室质量浓度为1μg/mL,逐渐递增至4μg/mL。于基础时间点、阿片类药输注30min后、丙泊酚达预设浓度1min后及意识消失即刻记录BIS、效应室质量浓度、改良警觉-镇静(OAA/S)评分。结果 3组的BIS与丙泊酚效应室质量浓度及OAA/S评分呈正相关。R组、S组患儿意识消失时的BIS值分别为77±6、76±7,均显著高于C组的66±7(P值均<0.05)。R组、S组的丙泊酚效应室质量浓度分别为(1.2±0.5)、(1.1±0.7)μg/mL,均显著低于C组的(2.4±0.5)μg/mL(P值均<0.05)。R组、S组从开始输注丙泊酚至意识消失的时间分别为(4.8±2.3)、(4.6±2.7)min,均显著短于C组的(8.3±1.6)min(P值均<0.05)。R组、S组50%患儿意识消失的丙泊酚效应室质量浓度(EC50)分别为1.02、0.98μg/mL,均显著低于C组的1.98μg/mL(P值均<0.05);R组和S组50%患儿意识消失时的BIS(BIS50)分别为85、83,均显著高于C组的75(P值均<0.05)。结论复合使用阿片类药物后,患儿丙泊酚意识消失的EC50降低。阿片类药物与丙泊酚相互作用可使意识消失时的BIS值升高,因此BIS值不能很好地反映患儿的镇静状态。Objective To quantitatively analyze the influence of opioids on propofol pharmacodynamics based on the changes of bispectral index（BIS）and propofol effect-site concentration during induction in pediatric patients.Methods Forty-five unpremedicated pediatric patients were randomly assigned to three groups：0.9% NaCl（group C）,0.02 μg·kg-1·min-1 sufentanil（group S）,and 0.3 μg·kg-1·min-1remifentanil（group R）.Thirty minutes later the patients were then given target-controlled effect site concentration infusion of propofol,with the initial concentration being 1 μg/mL,which increased gradually to 4 μg/mL.The target effect-site concentration of propofol,BIS value,observer＇s assessment of alertness/sedation（OAA/S）score and hemodynamic variables were observed at base-line time point,30 min after administration of opioids,1 min after propofol concentration reached the predefined level,and immediately after loss of consciousness.Results BIS was significantly correlated with OAA/S score and propofol effect-site concentration in all groups.The BIS values at loss of consciousness were 77±6 and 76±7 in R and S groups,respectively,which were significantly higher than that of group C（66±7,P0.05）;propofol effect-site concentrations were（1.2±0.5）and（1.1±0.7）μg/mL,respectively,which were significantly lower than that of group C（[2.4±0.5] μg/mL,P0.05）.The interval between administration of propofol and loss of consciousness in groups R and S were（4.8±2.3）and（4.6±2.7）min,respectively,which were significantly shorter than that in（[8.3±1.6] min,P0.05）.The median effective concentration（EC50）of propofol for loss of consciousness was 1.02 μg/mL in group R,0.98 μg/mL in group S,both were significantly lower than that in group C（1.98 μg/mL,P0.05）.The BIS50 values at loss of consciousness were 85 and 83 in group R and S,respectively,both were significantly higher than that in group C（75,P0.05）.Conclusions When sufentanil or remifentanil is combined with propof

关 键 词：脑电双频指数 阿片类药 丙泊酚 小儿麻醉 靶控输注 药物相互作用 

分 类 号：R726.1[医药卫生—儿科]