序贯法测定复合靶控输注丙泊酚时瑞芬太尼抑制帕金森病患者气管插管心血管反应的EC_(50)  

Up-and-down sequential method in determining median effective effect-site concentration (EC_(50))of remifentanil required for inhibiting intubation-induced hemodynamic responses in patients with Parkinson’s disease during target-controlled infusion of pro

作　　者：许小平[1] 王嘉锋[1] 余喜亚[1] 杨涛[1] 李金宝[1] 邓小明[1] 

机构地区：[1]第二军医大学长海医院麻醉科,上海200433

出　　处：《第二军医大学学报》2013年第8期868-873,共6页Academic Journal of Second Military Medical University

摘　　要：目的探讨复合靶控输注(TCI)丙泊酚时瑞芬太尼抑制帕金森病患者气管插管心血管反应的半数有效效应室靶浓度(EC50)。方法采用11配对病例对照研究方法,选择拟择期在全麻下行外科手术治疗的帕金森病患者31例,同时按照11配对的原则在同期住院的非帕金森病患者中选择对照31例,匹配条件为:同性别、年龄±3岁。两组患者均采用TCI丙泊酚和瑞芬太尼行麻醉诱导,设定丙泊酚效应室靶浓度为3μg/mL,瑞芬太尼效应室靶浓度采用改良序贯法确定,两组第1例患者瑞芬太尼的效应室靶浓度均为3ng/mL,相邻靶浓度之差为0.2ng/mL,以心率或收缩压变化幅度超过基础状态15%作为心血管反应阳性的判断标准。结果所有患者均未见胸壁强直,术后随访两组患者均未发生术中知晓。瑞芬太尼复合TCI丙泊酚抑制帕金森病患者气管插管时心血管反应的EC50为2.20ng/mL(95%CI:1.86～2.60ng/mL),而非帕金森病患者为2.93ng/mL(95%CI:2.72～3.15ng/mL),两者差异有统计学意义。结论复合TCI丙泊酚3μg/mL全麻诱导时,瑞芬太尼抑制帕金森病患者气管插管时心血管反应的EC50值小于非帕金森病患者。Objective To determine the median effective effect-site concentration （ECs0） of remifentanil required to inhibit hemodynamic responses induced by intuhation during target-controlled infusion （TCI） of propofol in patients with Parkinson＇s disease. Methods A 1 ： 1 matched case control design was used in the study. Thirty-one ASA I -Ⅱpatients with Parkinson＇s disease undergoing general anesthesia were enrolled, and 31 controls were the hospitalized patients with non- Parkinson＇s disease during the same period （same sex, age ~ 3 years old）. A TCI of propofol was used to maintain a predetermined effect-site concentration of 3μg/mI.. The target effect-site concentration of remifentanil was determined by a modified Dixon＇s up and-down sequential method. The initial target effect-site concentrations of remifentanil were 3 ng/mI, in the two groups and the increments or decrements between the two consecutive patients were 0.2 ng/mL. A positive response meant that either the heart rate or the systolic blood pressure was elevated by 15% in the first 5 min after intubation. Results There was no patient showed sign of muscle rigidity, and no patient recalled awareness during anesthesia in postoperative follow-up. During TCI of propofol, the ECs0 of remifentanil required for inhibiting intubation induced hemodynamic responses for patients with Parkinson＇s disease was 2.20 ng/mI. （95 % confidence interval： 1.86 2.60 ng/mL）. And the EC0 of remifentanil required for control group was significantly higher than for patients with Parkinson＇s disease （2.93 ng/mL, 95% confidence interval： 2.72-3. 15 ng/mL）. Conclusion When combined with TCI of propofol （target effect site concentration 3 μg/mL）, the ECs0of remifentanil required for inhibiting intubation induced hemodynamic responses for patients with Parkinson＇s disease is less than that for non Parkinson＇s disease.

关 键 词：帕金森病 瑞芬太尼 半数有效效应室靶浓度 丙泊酚 心血管反应 

分 类 号：R742.5[医药卫生—神经病学与精神病学]