不同剂量右美托咪定对七氟醚抑制患儿气管插管反应时半数有效呼气末浓度的影响  

Effects of different doses of dexmedetomidine on median effective end-tidal concentration of sevoflurane in- hibiting responses to tracheal intubation in pediatric patients

作　　者：贺琳[1] 王炫[1] 郑珊[2] 张学锋[1] 汤顺荣[1] 石赟[1] 

机构地区：[1]复旦大学附属儿科医院麻醉科,上海市201102 [2]复旦大学附属儿科医院外科,上海市201102

出　　处：《中华麻醉学杂志》2013年第11期1336-1338,共3页Chinese Journal of Anesthesiology

摘　　要：目的评价不同剂量右美托咪定对七氟醚抑制患儿气管插管反应时半数有效呼气末浓度（EC50）的影响。方法择期全麻手术患儿67例，性别不限，年龄3～8岁，体重为标准体重的150％以内，ASA分级Ⅰ或Ⅱ级，采用随机数字表法，将其分为3组：对照组（c组，n=22）不输注右美托咪定；不同剂量右美托咪定组（D1组，n=23；D2组，n=22）分别于麻醉诱导前经10min静脉输注右美托咪定1．0和2．0μg／kg，随后以0．5和1．09-g·kg-1·h-1的速率静脉输注。麻醉诱导：吸人5％七氟醚，睫毛反射消失后，调整呼气末七氟醚浓度至目标浓度并平衡15min，行气管插管，并行气管插管反应评分。采用序贯法进行试验，c组、D1组和D2组初始呼气末七氟醚浓度分别为3．5％、2．5％和1．5％，根据气管插管反应（气管插管反应评分〉1分为阳性反应）以1．2倍等比级增减，计算七氟醚EC50及其95％可信区间（95％CI）。记录右美托咪定给药后心血管事件的发生情况。结果D1组未发生心血管事件；D2组低血压发生率14％，心动过缓发生率9％。七氟醚EC50（95％CI）分别为：c组3．54％（3．39％～3．69％）、D1组2．37％（2．24％～2．46％）、D2组1．41％（1．37％～1．46％）。与C组比较，D1组和D2组EC50降低（P〈0．01）；与D1组比较，D2组EC50降低（P〈0．01）。结论对于患儿，复合七氟醚麻醉诱导时右美托咪定的适宜用量为负荷量1．0μg／kg，维持量0．5μg·kg-1·h-1。Objective To evaluate the effects of different doses of dexmedetomidine on median effective end-tidal concentration of sevoflurane （EC50） inhibiting responses to tracheal intubation in pediatric patients. Meth- ods Sixty-seven ASA physical status Ⅰ or Ⅱ patients, aged 3-8 yr, with body weight not exceeding 150 % of the ideal weight, scheduled for elective surgery under general anesthesia, were randomly divided into 3 groups using a random number table： control group （group C, n = 22） and different doses of dexmedetomidine groups （group D1 , n = 23; group D2 , n = 22） . Before induction of anesthesia, dexmedetomidine 1.0 and 2.0μg/kg was infused in- travenously over 10 min followed by infusion at a rate of 0.5 and 1.0μg. kg-1. h-1 in DI and D2 groups, respec- tively. Anesthesia was induced with inhalation of 5 % sevoflurane. After eyelash reflex disappeared, the end-tidal sevoflurane concentration was adjusted to achieve the target concentration and maintained at this level for 15 rain. Tracheal intubation was then performed and the response to intubation was scored. The initial end-tidal sevofluraneconcentration was 3.5%, 2.5% and 1.5% in C, D1 and D2 groups, respectively. Up-and-down sequential trial was used to determine the EC50 Each time the concentration of sevoflurane increased/decreased in the next patient depending on whether or not the response to intubation was positive. The positive response to intubation was defined as intubation score 〉 1. The ratio of concentrations between the two consecutive patients was 1.2. The EC50 and 95 % confidence interval of sevoflurane were calculated. The development of adverse cardiovascular events was recorded after dexmedetomidine administration. Results The adverse cardiovascular events were not observed in D1 group. The incidence of hypotension and brachycardia was 14% and 9% in D2 group. The EC50 （95% confi- dence interval） of sevoflurane was 3.54% （3.39%-3.69%）, 2.37% （2.24%-2.46%） and 1.41% （1.37%- 1.46% ） in C, D1 and D2 gro

关 键 词：右美托咪定 麻醉药 吸入 插管法 气管内 剂量效应关系 药物 儿童 

分 类 号：R726.1[医药卫生—儿科]