瑞芬太尼抑制气管拔管期心血管反应的最低有效浓度的测定  

Minimal effective remifentanil concentration for inhibiting hemodynamic responses to tracheal extubation

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：《中华损伤与修复杂志（电子版）》2013年第2期43-45,共3页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

摘　　要：目的测定瑞芬太尼抑制50%患者气管拔管期心血管反应的靶控输注(TCI)血浆靶浓度(EC50),以指导瑞芬太尼临床应用。方法选取26例在全身麻醉下行腰椎间盘摘除术患者。预设第1例患者拔管时瑞芬太尼TCI血浆靶浓度为2ng/mL,依据Dixon上下序贯法原则决定下1例患者拔管时的瑞芬太尼血浆靶浓度。同时记录患者麻醉诱导前、拔管期瑞芬太尼达到预设靶浓度时、气管拔管即刻及拔管后5min内的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SPO2)、脑电双频谱指数(BIS)以及拔管期患者有无呛咳。结果采用Dixon序贯法计算得到的瑞芬太尼抑制腰椎手术患者气管拔管期血流动力学反应的EC50为1.57ng/mL,其95%可信区间(CI)为1.45～1.69ng/mL。结论联合丙泊酚全凭静脉麻醉拔管期,抑制50%患者心血管反应的瑞芬太尼TCI血浆靶浓度为1.57ng/mL。Objective To study the minimal effective concentration （EC50） of remifentanil plasma for inhibiting hemodynamic response to tracheal extubation. Methods Twenty-six ASA Ⅰ-Ⅱ patients at the age of 18-65 years admitted to hospital from May 2012 to August 2012 for diskectomy. Remifentanil plasma target concentration of 2. 0 ng/mL was chosen for the first patient. The Dixon’s up-and-down sequential allocation method was used for determining the next remifentanil concentration. The Mean arterial pressure （MAP） ,heart rate （HR） ,pulse oxygen saturation （SpO2） ,and bispectral index （BIS） were recorded during the time before anesthesia induced period,remifentanil TCI reaching the predetermined concentration, the immediate extubation and 1-5 min after extubation. Meanwhile cough reflex was recorded during tracheal extubation. Results The EC 50 of remifentanil to inhibit the hemodynamic response to tracheal extubation was 1. 57 ng/mL and its 95% CI was 1. 45-1. 69 ng/mL according the Dixon’s up-and-down sequential allocation. Conclusion Remifentanil at the concentration of 1. 57 ng/mL can effectively inhibit the hemodynamic response to tracheal extubation in 50% patients when combined with propofol.

关 键 词：瑞芬太尼 靶控输注 并发症 气管拔管 

分 类 号：R614[医药卫生—麻醉学]