不同剂量右美托咪啶对异丙酚抑制老年患者Supreme喉罩置入反应EC50的影响  

Effect of different doses of dexmedetomidine on median effective concentration of propofol required to prevent response to Supreme laryngeal mask airway insertion in aged patients

作　　者：姜燕[1] 王世端[1] 黄辉[1] 刘陕岭[1] 栾海虹[1] 孙健[1] 

机构地区：[1]青岛大学医学院附属医院麻醉科,266003

出　　处：《中华麻醉学杂志》2012年第7期805-807,共3页Chinese Journal of Anesthesiology

摘　　要：目的评价不同剂量右美托咪啶对异丙酚抑制老年患者Supreme喉罩置入反应半数有效血浆靶浓度（EC50）的影响。方法择期全麻膝关节手术患者，性别不限，年龄≥65岁，体重指数20～28kg／m2，ASA分级Ⅰ或Ⅱ级，采用随机数字表法，将患者随机分为3组：小剂量右美托咪啶组（D1组）和大剂量右美托咪啶组（D2组）分别静脉输注右美托咪啶0．4和0．8μg／kg，输注时间10min，对照组（C组）给予等容量生理盐水，靶控输注异丙酚，C组、D1组和D2组第1例患者血浆靶浓度分别为3．5、3．0和2．6μg／ml，待血浆靶浓度和效应室靶浓度达到平衡，BIS值50～60时，开始置入喉罩。根据是否发生喉罩置入反应确定下1例患者的异丙酚靶浓度，相邻靶浓度的比值为1．1，置入喉罩时出现体动、口角动、牙咬喉罩、呛咳、吞咽等为阳性反应。计算异丙酚抑制喉罩置入反应的EC。及其95％可信区间（95％CI）。结果C组、D1组和D2组异丙酚抑制喉罩置入反应的EC。及其95％c1分别为3．57（2．91～3.87）、3．09（2．66～3．53）和2．62（2．30～3．15）μg／ml。D．组和D2组EC50低于C组，D2组EC50低于D．组（P〈0．05）。结论静脉输注右美托咪啶0．4和0．8μg／kg均可降低异丙酚抑制老年患者Supreme喉罩置入反应的EC50，0．8μg／kg效应更明显。Objective To investigate the effect of different doses of dexmedetomidine on the median effective concentration （EC50） of propofol required to prevent the response to Supreme laryngeal mask airway （LMA） insertion in aged patients.Methods ASA I or II patients of both sexes, aged 〉165 yr, with a body mass index of 20-28 kg/m2 , undergoing knee operation under general anesthesia, were randomly divided into 3 groups： control group （group C）, small dose dexmedetomidine group （group DI ） and large dose dexmedetomidine group （group D2 ）. Dexmedetomidine 0.4 and 0.8 μg/kg were infused intravenously over 10 rain in groups D1 and D2 respectively, while group C received the equal volume of normal saline instead. Anesthesia was induced with target-controlled infusion of propofol. The initial target plasma concentration of propofol was set at 3.5, 3.0 and 2.6 μg/ml in groups C, D1 and D2 respectively. Following equilibration between the plasma and effect-site concentration of propofol, LMA was inserted when BIS value was 50-60. EC50 was determined by up-and-down sequential trial. The target plasma concentration of propofol increased/decreased by 10% in the next patient depending on whether or not the LMA insertion response occurred. Positive LMA insertion response was defined as body movement, corner of the mouth movement, biting LMA, bucking and/or wallowing during insertion. The ECso and 95 % confidence interval （CI） of propofol required to prevent LMA insertion response were calculated with sequential method. Results EC50（95% CI） of propofol was 3.57 μg/ml （2.91-3.87 μg/ml）, 3.09 μg/ml （2.66-3.53 μg/ml） and 2.62 μg/ml （2.30-3.15 μg/ml） in groups C, D1 and D2 respectively. ECs0 was significantly lower in groups D1 and D2 than in group C, and in group D2 than in group Dt （ P 〈 0.05 ）. Conclusion Dexmedetomidine 0.4 and 0.8 μg/kg infused intravenously Can reduce the ECs0 of propofol required to prevent the response to Supreme LMA insertion in aged patients, and the e

关 键 词：右美托咪啶 二异丙酚 剂量效应关系 药物 喉面罩 老年人 

分 类 号：R614[医药卫生—麻醉学]