瑞芬太尼抑制老年患者气管插管反应的最低有效浓度  

Minimal effective remifentanil concentration for inhibiting response to tracheal intubation in elderly patients

作　　者：王晓燕[1] 孙雪峰[1] 郝建华[1] 米卫东[2] 

机构地区：[1]解放军总医院第一附属医院麻醉科,北京100048 [2]解放军总医院麻醉科,北京100853

出　　处：《解放军医学院学报》2013年第5期481-483,488,共4页Academic Journal of Chinese PLA Medical School

摘　　要：目的探讨抑制50%老年患者气管插管过程中血流动力学波动的瑞芬太尼靶控输注（TCI）血浆靶浓度（EC50）。方法选择我院2012年3-6月期间,26例年龄65~78岁ASAⅠ-Ⅱ级拟行2 h以内择期手术患者。所有患者在脑电双频指数（bispectralindex,BIS）引导下丙泊酚联合瑞芬太尼全凭静脉诱导抑制丙泊酚TCI血浆靶浓度3μg/ml,预设第1例患者瑞芬太尼TCI血浆靶浓度4 ng/ml,依据Dixon上下序贯法原则决定下一例患者的瑞芬太尼血浆靶浓度。结果气管插管前、后BIS值无明显差异。采用Dixon序贯法计算得到的瑞芬太尼抑制老年患者气管插管血流动力学反应的EC50为1.93 ng/ml,其95%可信区间（CI）为1.63~2.23 ng/ml。结论在维持丙泊酚TCI 3μg/ml时,1.93 ng/ml瑞芬太尼可抑制50%老年患者接受气管插管时的心血管反应。Objective To study the effective remifentanil plasma concentration（EC50） for inhibiting hemodynamic response to tracheal intubation in 50% elderly patients when propofol anesthesia was guided by bispectral index（BIS）.Methods Twenty-six ASAⅠ-Ⅱelderly patients at the age of 65-78 years admitted to our hospital from March 2012 to June 2012 for surgery within 2 hours after admission were included in this study.The patients received target-controlled infusion of 3 μg/ml propofol.The plasma target concentration of remifentanil was preset at 4.0 ng/ml for the first patient whose target plasma remifentanil concentration was decided according to the Dixon＇s up-and-down sequential allocation.Results No significant difference was found in BIS value before and after tracheal intubation.The EC50 of remifentanil to inhibit the hemodynamic response to tracheal intubation was 1.93 ng/ml and its95% CI was 1.63-2.23 ng/ml according the Dixon＇s up-and-down sequential allocation.Conclusion Remifentanil at the concentration of 1.93 ng/ml can effectively inhibit the hemodynamic response to tracheal intubation in 50% elderly patients when the concentration of propofol is maintained at 3 μg/ml.

关 键 词：血浆靶浓度 瑞芬太尼 气管插管 老年人 

分 类 号：R614[医药卫生—麻醉学]