丙泊酚复合芬太尼在小儿上消化道内镜术中的半数有效剂量  

Median effective dose of propofol combined with fentanyl in pediatric upper gastrointestinal endoscopy

作　　者：汪莉[1] 何旋[1] 柳璐[1] 向强[1] 

机构地区：[1]武汉市妇女儿童医疗保健中心,武汉430030

出　　处：《实用药物与临床》2014年第12期1568-1570,共3页Practical Pharmacy and Clinical Remedies

摘　　要：目的 探讨门诊对小儿行上消化道内镜术时,复合少量芬太尼、丙泊酚静脉诱导的半数有效剂量.方法 观察47例ASA Ⅰ级拟行无痛胃镜检查的门诊患儿,首先均静推芬太尼1μg/kg,5min后再按1 mg/（kg· min）的速度静脉泵注丙泊酚.丙泊酚的起始诱导剂量为2 mg/kg,根据麻醉诱导是否能满足检查需要,采用改良Dixon序贯法,减少或增加0.5 mg/kg丙泊酚,确定下一位患儿的诱导剂量.如出现眼睑反射未消失,下颌紧闭,牙垫,胃镜导管不能置入或置入时患儿有明显体动,出现呛咳及喉痉挛阳性反应,下例患儿丙泊酚诱导剂量增加0.5 mg/kg,若能满足检查需要未出现阳性反应,则下例患儿丙泊酚诱导剂量减少0.5 mg/kg.结果 Probit 分析表明,小儿在胃镜检查时复合1 μg/kg芬太尼,丙泊酚诱导的半数有效剂量（ED50）为4.2 mg/kg（95％ CI：3.9 ～4.7 mg/kg）,95％的有效剂量（ED95）为5.7 mg/kg（95％CI：5.2 ～ 6.3 mg/kg）.结论 复合1μg/kg芬太尼时,能使50％的儿童满足无痛胃镜检查的丙泊酚静脉诱导剂量为4.2 mg/kg,使95％的儿童满足无痛胃镜检查的诱导剂量为5.7 mg/kg.Objective To explore the median effective dose of propofol combined with fentanyl intravenous anesthesia in pediatric upper gastrointestinal endoscopy.Methods 47 pediatric patients with ASA Ⅰ undergoing upper gastrointestinal endoscopy were enrolled.5 min after the injection of 1 μg/kg fentanyl,propofol was given iv at rate of 1 mg/（kg·min）.The initial dose of propofol was 2 mg/kg.A positive reaction consisted in muscle tension,disappearance of eyelash relaxation,movement,bucking and laryngospasm when entering scopy.If the successful response was acheived,the dose of 0.5 mg/kg propofol decreased for the next patient using the modified Dixon＇s up-and-down method,if the response was dissatisfactory,the dose of 0.5 mg/kg propofol increased.Results The probit analysis showed that,the 50％ effective dose（ED50） of propofol combined with 1 μg/kg fentanyl was 4.2 mg/kg for pediatric patient in upper gastrointestinal endoscopy （95 ％ CI：3.9 ～ 4.7 mg/kg）.The 95 ％ effective dose （ED95） was 5.7 mg/kg （95 ％ CI：5.2 ～6.3 mg/kg）.Conclusion When combined with 1 μg/kg fentanyl,the dose of propofol required for 50％ pediatric patients aged 3 to 6 years old in upper gastrointestinal endoscopy is 4.2 mg/kg,and the dose of propofol required for 95％ pediatric patient is 5.7 mg/kg.

关 键 词：小儿 丙泊酚 芬太尼 静脉麻醉 上消化道内镜术 

分 类 号：R726.1[医药卫生—儿科]