加工分离程序结合词干补笔法测定盐酸右美托咪啶引起外显记忆消失的半数有效血药浓度  

Determination of EC_(50) of Dexmedetomidine Hydrochloride Causing Disappearance of Explicit Memory by Process Dissociation Procedure

作　　者：郭瑞[1] 何婉雯[1] 王立勋[1] 李辉[1] 陈友利[1] 李建宾[1] 

机构地区：[1]南方医科大学附属小榄医院麻醉科,中山528415

出　　处：《医药导报》2016年第4期341-344,共4页Herald of Medicine

基　　金：广东省中山市科技计划项目(2014A1FC117)

摘　　要：目的通过加工分离程序（PDP）结合词干补笔法序贯测定盐酸右美托咪啶（DEX）引起外显记忆消失半数有效血药浓度（EC50）。方法选择美国麻醉医师协会Ⅰ或Ⅱ级,无听力障碍、语言困难、神经系统功能紊乱、术前未用影响中枢系统的药物治疗,中专（高中）以上文化程度,拟行下肢手术的患者40例。采用心理学界广泛应用的PDP结合词干补笔法,制定《学习表》及《测试表》录音,计算外显记忆和内隐记忆,记忆成绩与0进行统计学比较,0视为记忆消失。然后采用序贯法测定：根据外显记忆是否消失决定下例患者靶控浓度升降,第1例患者靶血浆药物浓度定为4 ng·mL^-1,两相邻患者靶控浓度比值为1.2,前1例患者外显记忆消失则下例患者减少1个浓度梯度,前1例患者外显记忆未消失则下1例患者增加1个梯度,依此类推,直至40例患者测试完毕,记录每一例患者的测试参数,并计算DEX的半数有效剂量（D1）及其95%可信区间。结果 DEX引起外显记忆消失的ED50为5.23 ng·mL^-1,其95%可信区间为4.07～6.39 ng·mL^-1。结论临床中,靶控输注DEX浓度为5.23 ng·mL^-1水平镇静时,可消除半数患者外显记忆,避免术中知晓。Objective To determine the EC50 of dexmedetomidine hydrochloride（ DEX） which causes disappearance of explicit memory by process dissociation procedure（ PDP）. Methods Forty patients those who had senior middle school or higher educational background undergoing lower extremity surgery with grade ASA Ⅰ or Ⅱ,without hearing impairment,dysphasia,nervous system disorders,and having no drugs in the treatment of the central nervous system were included. PDP was applied to establish study table and record,and calculate performance of explicit memory and implicit memory. Memory performance was statistically compared with 0,0 memory was considered to be statistically significant and disappearance,respectively.Sequential method was used for determination.According to explicit memory disappearance or not,target concentration of the next patient was adjusted（ increase or decrease）.DEX target concentration of the first patient was set to 4 ng·mL^-1,and the ratio of target concentration between the adjacent patients was 1.2.If the explicit memory of the former patient disappeared,the target concentration of the next patient was decreased by 1 concentration gradient; if the explicit memory of the former patient did not disappear,the target concentration of the next patient was increased by 1 concentration gradient,and so forth. All the 40 patients were determined.The median effective dose（ D1） and 95% confidence interval（ CI） of DEX were calculated. Results The ED50 of DEX causing explicit memory disappearance was 5.23 ng·mL^-1,and the 95% CI was 4.07-6.39 ng·mL^-1.Conclusion In clinical,target concentration of dexmedetomidine hydrochloride 5.23 ng·mL^-1levels for sedation,can cause half of patients＇ explicit memory disappear,so as to avoid intraoperative awareness.

关 键 词：右美托咪啶 盐酸 外显记忆消失 半数有效浓度 

分 类 号：R971.3[医药卫生—药品] R969.4[医药卫生—药学]