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机构地区:[1]镇江市第一人民医院麻醉科,212002 [2]南京市鼓楼医院麻醉科
出 处:《临床麻醉学杂志》2014年第9期859-862,共4页Journal of Clinical Anesthesiology
摘 要:目的探讨右美托咪定对抑制喉罩插入反应所需瑞芬太尼剂量的影响。方法拟行乳房肿瘤切除术患者60例,随机分为三组:麻醉诱导前分别输注生理盐水(D1组)和右美托咪定0.25μg/kg(D2组)和0.5μg/kg(D3组)。泵注结束后用效应室靶控输注丙泊酚,靶浓度设定为3.5μg/ml。采用改良Dixon’s序贯法进行研究,靶控丙泊酚3min后效应室靶控输注瑞芬太尼,D1、D2和D3组设定初始靶浓度分别为1.9、1.1和0.8ng/ml,3min后插入SLIPA喉罩。如插入喉罩出现体动等阳性反应,下1例患者上调1个浓度梯度,如未出现则下1例患者下调1个浓度梯度,相邻瑞芬太尼浓度差值为0.2ng/ml,直至出现6个阳性和阴性反应交替现象。阳性和阴性反应交替的中点对应的瑞芬太尼浓度的均值为瑞芬太尼抑制喉罩插入反应的半数有效效应室浓度(Ce50)。结果 D1、D2和D3组瑞芬太尼抑制插入喉罩反应的Ce50(95%CI)分别为1.90ng/ml(1.65~2.15ng/ml)、1.05ng/ml(0.91~1.20ng/ml)和0.55ng/ml(0.32~0.79ng/ml)。D2和D3组Ce50均明显低于D1组,且D3组Ce50明显低于D2组(P<0.05)。结论丙泊酚全麻时应用右美托咪定能剂量依赖性地减少插入喉罩所需的瑞芬太尼用量。Objective To explore the effect of dexmedetomidine on remifentanil requirement for inhibiting the response to inserting largngeal mask(LMA)in propofol anesthesia.Methods Sixty patients scheduled for mammary neoplasms surgery were randomly allocated to three groups:groups D1,D2 and D3.Saline or dexmedetomidine 0.25 and 0.5μg/kg were administered in groups D1,D2 and D3,respectively.Propofol was effective-site target controlled infused following saline and dexmedetomidine administration completion and the concentration was set at 3.5μg/ml.Three minutes after propofol infusion,remifentanil was effective-site target controlled infused and the concentration was determined by a modification of Dxion’s up-and-down method.The initial concentration of remifentanil in group D1,D2 and D3were set at 1.9ng/ml,1.1ng/ml and 0.8ng/ml,respectively.The LMA was inserted three minutes following remifentanil infusion.The concentration of remifentanil for consecutive patients in each group was determined by the response of the previous patient,using increments or decrements of 0.2ng/ml.The process was repeated until the sixth cross-over point was obtained.The Ce50 was defined as the mean cross-over midpoint in each group.Results The Ce50(95%CI)of remifentanil for preventing the response to inserting LMA were 1.90ng/ml(1.65-2.15ng/ml)and 1.05ng/ml(0.91-1.20ng/ml)and 0.55ng/ml(0.32-0.79ng/ml),respectively,for groups D1,D2 and D3.The Ce50 of remifentanil in groups D2 and D3were significantly lower than that in group D1(P〈0.05).The Ce50 of remifentanil in group D3 was significantly decreased compared to that in group D2(P〈0.05).Conclusion Dexmedetomidine can attenuate remifentanil requirement for inhibiting the response to inserting LMA in a dose-dependent manner during propofol anesthesia.
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