复合异丙酚时舒芬太尼抑制老年患者喉罩置入反应的半数有效效应室靶浓度  

Median effective target effect-site concentration of sufentanil inhibiting responses to insertion of laryngeal mask airway when combined with propofol in elderly patients

作　　者：刘玲[1] 李波[1] 孙健[1] 吕国义[1] 

机构地区：[1]天津医科大学第二医院麻醉科300211

出　　处：《中华麻醉学杂志》2014年第7期824-825,共2页Chinese Journal of Anesthesiology

摘　　要：目的 确定复合异丙酚时舒芬太尼抑制老年患者喉罩置入反应的半数有效效应室靶浓度（EC50）.方法 择期全麻下经尿道前列腺电切术患者,年龄66 ～ 75岁,BMI 19 ～ 30 kg/m2,ASA分级Ⅰ或Ⅱ级.麻醉诱导：靶控输注异丙酚,起始效应室靶浓度1 μg/ml,每隔1 min靶浓度递增0.5 μg/ml,直至靶浓度达2 μg/ml时维持5 min.同时靶控输注舒芬太尼,第1例患者效应室靶浓度为0.3 ng/ml,待患者意识消失且效应室浓度与血浆浓度达平衡后行喉罩置入术,发生喉罩置入反应时,则下一例患者采用高一级浓度,否则采用低一级浓度,相邻浓度比值为1.2.发生喉罩置入反应的标准：喉罩置入术后5 min内患者MAP和HR升高幅度超过基础值20％.采用Probit法计算舒芬太尼抑制喉罩置入反应的EC50及其95％可信区间.结果 复合异丙酚时舒芬太尼抑制老年患者喉罩置入反应的EC50及其95％可信区间为0.160 （0.130～0.188） ng/ml.结论 复合异丙酚时舒芬太尼抑制老年患者喉罩置入反应的EC50为0.160 ng/ml.Objective To determine the median effective target effect-site concentration （EC50） of sufentanil inhibiting responses to insertion of laryngeal mask airway （LMA） when combined with propofol in the elderly patients.Methods ASA physical status Ⅰ or Ⅱ patients,aged 66-75 yr,with body mass index of 19-30 kg/m2,scheduled for elective transurethral resection of prostate under general anesthesia,were included in this study.Anesthesia was induced with propofol given by target-controlled infusion.The initial target effect-site concentration （Ce） of propofol was 1 μg/ml,and the Ce was increased by 0.5 μg/ml every 1 min until it was increased to 2 μg/ml and maintained at this level for 5 min.Sufentanil was simultaneously administered by target-controlled infusion.The target Ce of sufentanil was 0.3 ng/ml in the first patient.The concentration of sufentanil was determined using the modified Dixon＆#39;s up-and-down method.After the patients lost consciousness,LMA was inserted after the target effect-site and plasma concentrations were balanced.The insertion response was defined as positive when MAP and HR increased by 20% of the baseline value within 5 min after insertion of LMA.The Ce of sufentanil was increased/decreased in the next patient if the insertion response was positive or negative.The ratio between the two successive concentrations was 1.2.The EC50 and 95 % confidence interval of sufentanil blunting responses to insertion of LMA was calculated using Probit analysis.Results When combined with propofol,the EC50 （95% confidence interval） of sufentanil blunting responses to insertion of LMA was 0.160 （0.130-0.188） ng/ml.Conclusion The EC50 of sufentanil inhibiting responses to insertion of LMA is 0.160 ng/ml when combined with propofol in the elderly patients.

关 键 词：舒芬太尼 二异丙酚 老年人 剂量效应关系 药物 

分 类 号：R614[医药卫生—麻醉学]