靶控输注依托咪酯意识消失的半数有效量的测定  

Determination of EC_(50) amnesic concentration of etomidate by target-controlled infusion

作　　者：王彬[1,2] 程庆好 李蕾 曲银娥[2] 

机构地区：[1]煤炭总医院麻醉科,北京市100028 [2]河北联合大学基础医学院解剖与组培教研室,河北省唐山市063009

出　　处：《中华全科医学》2015年第2期202-204,207,共4页Chinese Journal of General Practice

摘　　要：目的 依托咪酯是一种非巴比妥类的静脉麻醉药,半衰期短。依托咪酯具有起效快、作用时间短、体内代谢迅速、恢复平稳、对心血管系统和呼吸系统抑制轻微、有脑保护的作用等特点,在临床上被麻醉医师广泛的应用。测定靶控输注依托咪酯镇静的半数有效量以及95%有效量。了解EC50（半数有效浓度）及EC95（95%有效浓度）剂量可以帮助确定依托咪酯的安全范围与有效范围;增加依托咪酯应用的安全性;提高麻醉质量与患者的舒适程度;提高合理用药。方法 选择煤炭总医院2013年1—5月择期椎管内麻醉下行下腹部或下肢手术患者41例。ASAⅠ-Ⅱ级;采用靶控输注依托咪酯镇静。将其随机分为4组,靶控浓度分别为0.2μg/ml、0.3μg/ml、0.4μg/ml、0.5μg/ml观察30 min。每隔5 min记录患者警觉/镇静评分法（OAA/S）、血压、心率、呼吸次数、血气等监测指标。改良OAA/S评分为3分以上患者视为入睡。所有患者均不给术前药,同时记录药后患者镇静程度改变情况;计算靶控输注依托咪酯使患者意识消失的EC50及EC95。结果 TCI靶控输注依托咪酯的半数有效浓度为0.333μg/ml,95%可信限为0.284-0.374μg/ml;依托咪酯EC95为0.468μg/ml;95%可信限为0.412-0.491μg/ml。结论 依托咪酯靶控输注具有血流动力学稳定、对呼吸影响小,同时具有较低的肌阵挛发生率,可以广泛的应用于临床镇静和麻醉。临床推荐剂量为0.333-0.468μg/ml。Objective To determine EC50（ median effective concentration） and EC95（ 95% effective concentration） by target-controlled infusion（ TCI）,improve the quality of anesthesia and patient comfort. Methods Forty-one ASA Ⅰ-Ⅱpatients undergoing lower abdominal or lower limb surgery under combined spinal-epidural anesthesia（ CSEA） in our hospital from January to May in 2013 were enrolled in this study. Etomidate was used by target controlled infusion（ TCI）. The concentration of etomidate were 0. 2 μg / ml,0. 3 μg / ml,0. 4 μg / ml,0. 5 μg / ml. Alertness / sedation score（ OAA / S）,blood pressure,heart rate,respiratory rate were recorded every five minutes,blood gas monitoring were also recorded. The patients with modified OAA / S score of 3 points or more were considered to fall asleep. All patients were not given the drug before surgery. EC50 and EC95amnesic concentration of TCI etomidate were calculated. Results EC50 amnesic concentration of TCI etomidate was 0. 333 μg / ml,95% confidence limits were 0. 284- 0. 374 μg / ml. EC95 amnesic concentration of TCI etomidate was 0. 468 μg / ml,95% confidence limits were 0. 412- 0. 491 μg / ml. Conclusion Etomidate by TCI have hemodynamic stability,little adverse impact on respiration and low incidence of myoclonus. Etomidate can be widely used in clinical sedation and anesthesia. The recommending clinical dose is 0. 333- 0. 468 μg / ml.

关 键 词：靶控输注 依托咪酯 半数有效浓度 

分 类 号：R614.2[医药卫生—麻醉学]