复合七氟醚时地佐辛用于上腹部手术患者麻醉的适宜剂量  

Optimum dose of dezocine when combined with sevoflurane for upper abdominal surgery

作　　者：吕帅国[1] 杨现会[2] 吕淼淼[2] 袁峰[2] 吕志峰[3] 付红光[2] 孙凯[2] 李廷坤[1] 卢锡华[1] 董铁立[1] 

机构地区：[1]郑州大学附属肿瘤医院麻醉科 [2]郑州大学第二附属医院麻醉科,450014 [3]河南中医学院第一附属医院麻醉科

出　　处：《中华麻醉学杂志》2014年第12期1446-1448,共3页Chinese Journal of Anesthesiology

基　　金：2012年度河南省医学科技攻关计划项目（201204026）;2012年河南省基础研究计划项目（122300410075）

摘　　要：目的 确定复合七氟醚时地佐辛用于上腹部手术患者麻醉的适宜剂量.方法 择期行上腹部手术患者,性别不限,年龄29 - 64岁,体重45-75 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其分为4组：对照组（C组）和不同剂量地佐辛组（D组、D2组和D3组）.麻醉诱导前即刻C组、D1组、D2组和D3组分别静脉注射生理盐水5ml、地佐辛0.1、0.2和0.3 mg/kg（用生理盐水稀释到5ml）.吸入8％七氟醚麻醉诱导,待患者意识消失后静脉注射琥珀酰胆碱1.5 mg/kg,气管插管后行机械通气.C组、D1组、D2组和D3组第1例患者七氟醚呼气末浓度分别设定为3.0％.、3.0％、2.5％和2.0％,当七氟醚呼气末浓度达到预定水平并维持15 min以上且神经肌肉功能恢复后开始切皮.采用序贯法确定下一例患者的七氟醚的呼气末浓度,若上一例患者切皮时发生体动反应,则下一例患者增加一个浓度梯度,否则降低一个浓度梯度,相邻浓度比值为0.2,直至出现6个或以上交叉点,取6个交叉点患者七氟醚呼气末浓度的平均值作为七氟醚抑制50％患者切皮诱发体动反应的最低肺泡有效浓度（MAC）,并计算95％可信区间.记录低血压和心动过缓的发生情况.结果 C组、D1组、D2组、D3组七氟醚MAC （95％可信区间）分别为2.4％（2.2％-2.6％）、1.8％（1.5％-2.1％）、1.4％（1.2％-1.6％）、1.2％（0.9％-1.5％）.与C组比较,D1组、D2组和D3组七氟醚MAC降低（P＜0.05）;与D1组比较,D2组和D3组七氟醚MAC降低（P＜0.05）;D2组和D3组七氟醚MAC比较差异无统计学意义（P＞0.05）.4组间心动过缓和低血压发生率比较差异无统计学意义（P＞0.05）.结论 复合七氟醚时地佐辛用于上腹部手术患者麻醉的适宜剂量为0.2 mg/kg.Objective To determine the optimum dose of dezocine when combined with sevoflurane for upper abdominal surgery.Methods ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 29-64 yr,weighing 45-75 kg,undergoing elective upper abdominal surgery under general anesthesia,were randomly divided into 4 groups using a random number table：control group （group C） and different doses of dezocine groups （D1,D2 and D3 groups）.Dezocine 0.1,0.2 and 0.3 mg/kg （in 5 ml of normal saline） was intravenously injected immediately before induction of anesthesia in D1,D2 and D3 groups,respectively,while 5 ml of normal saline was given instead in group C.Anesthesia was induced with 8 ％ sevoflurane inhalation.As soon as the patients lost consciousness,tracheal intubation was facilitated with succinyl choline 1.5 mg/kg.The patients were mechanically ventilated.Anesthesia was maintained with sevoflurane.The first patient received sevoflurane with the end-tidal concentrations of 3.0％,3.0％,2.5％ and 2.0％ in C,D1,D2 and D3 groups,respectively.After at least 15 min of equilibration and when neuro-muscular function returned to T4/T1 ≥ 0.7,skin incision in 50％ of patients was made.The end-tidal concentration of sevoflurane was determined by modified Dixon＇ s up-and-down sequential experiment.According to the patient＇s somatic responses,the end-tidal concentrationofsevoflurane w asincreased/ decreased in the next patient.The ratio between the two successive concentrations was 0.2.At least six independent crossover pairs were observed in each group.The minimum alveolar concentration （MAC） of sevoflurane for blunting the body movement evoked by skin incision in 50％ of patients-was determined,and 95％confidence interval （CI） was calculated.The development of hypotension and bradycardia was recorded.Results The MAC （95％ CI）ofsevoflurane was 2.4％ （2.2％-2.6％）,1.8％ （1.5％-2.1％）,1.4％ （1.2％-1.6％）and 1.2％ （0.9％-1.5％） in C,D1,D2 and D3 groups,respectively.The MAC of

关 键 词：镇痛药 阿片类 麻醉药 吸入 剂量效应关系 药物 

分 类 号：R614[医药卫生—麻醉学]