心率变异性监测靶控输注瑞芬太尼用于下颌骨骨折患者清醒经鼻盲探气管插管的效应室浓度EC_(50)  

EC_(50) of remifentanil by TCI during nasotracheal intubation for conscious patients with mandible fractures monitored by heart rate variability

作　　者：李荣[1] 陈彪[1] 蔡强[1] 王静[1] 沈宇钢[1] 吴娟[1] 

机构地区：[1]包头医学院第一附属医院麻醉科,包头014010

出　　处：《山西医科大学学报》2015年第11期1145-1149,共5页Journal of Shanxi Medical University

基　　金：包头市医药卫生科技计划项目(wsjj2013088)

摘　　要：目的测定瑞芬太尼用于下颌骨骨折患者清醒经鼻盲探气管插管的半数有效效应室靶控输注浓度(EC50),同时测定靶控效应室浓度与心率变异性(HRV)的相关关系。方法选择ASAⅠ-Ⅱ级,择期行下颌骨骨折手术患者30例,HRV监测下环甲膜穿刺利多卡因气管表面麻醉后,瑞芬太尼靶控输注达效应室浓度后,开始经鼻盲探气管插管。瑞芬太尼靶控输注效应室浓度按Dixon-Mood序贯法确定,起始浓度为3 ng/ml,相邻患者的浓度的对数差值为0.05。结果 Dixon-Mood法公式计算出靶控输注瑞芬太尼用于下颌骨骨折患者清醒经鼻盲探气管插管的效应室浓度EC50为3.01 ng/ml,95%CI为2.92-3.11 ng/ml;Probit回归法计算所得的EC50为3.01 ng/ml,95%CI为2.68-3.38 ng/ml。与入室时相比,达靶控浓度时的LF/HF值明显降低(P<0.05)。瑞芬太尼效应室靶控浓度与患者插管前达靶控浓度时(r1=-0.842,P<0.01)及插管时(r2=-0.804,P<0.01)HRV的LF/HF值呈负相关。结论靶控输注瑞芬太尼用于下颌骨骨折患者清醒经鼻盲探气管插管的效应室浓度EC50为3.01 ng/ml,效应室浓度与LF/HF值呈负相关关系。Objective To investigate the medium effective effect-site concentration（ EC50） of remifentanil by TCI during nasotracheal intubation for conscious patients with mandible fractures,and to explore its correlation with heart rate variability（ HRV）. Methods Thirty ASA Ⅰ- Ⅱ patients with mandible fractures were enrolled in this study. Monitored by HRV,patients underwent topical anesthesia in trachea with 2% lidocaine injected through cricothyroidmembrane. Then the nasotracheal intubation began after effect-site concentration of remifentanil by TCI got the target. The effect-site concentration of remifentanil was defined by Dixon-Mood method,the first value was 3 ng / ml,and the difference between the log of the two adjacent concentrations was 0. 05. Results With Dixon-Mood method,the EC50 of remifentanil by TCI during the nasotracheal intubation for conscious patients with mandible fractures was 3. 01 ng /ml,95% CI was 2. 92- 3. 11 ng / ml. Probit regression analysis showed that EC50 was 3. 01 ng / ml,95% CI was 2. 68- 3. 38 ng / ml.When effect-site concentration of remifentanil by TCI got target,the value of LF / HF was lower than that at time of entering operation room. The effect-site concentration of remifentanil was negatively correlated with the values of LF / HF at time of effect-site concentration of remifentanil by TCI getting target（ r1=- 0. 842,P 0. 01） and at time of nasotracheal intubation（ r2=- 0. 804,P 0. 01）. Conclusion The EC50 of remifentanil by TCI during nasotracheal intubation for conscious patients with mandible fractures is 3. 01 ng / ml,and the effect-site concentration of remifentanil shows negative correlation with the values of LF / HF.

关 键 词：瑞芬太尼 经鼻气管插管 效应室靶控输注 EC50 HRV 

分 类 号：R614[医药卫生—麻醉学]