异丙酚复合依托咪酯诱导下对不同性别罗库溴铵气管插管的半数有效剂量影响  

Effect of median dose of rocuronium on rapid tracheal intubation following propofol combined with etomidate in male and female

作　　者：宋雯[1] 吕国义[1] 

机构地区：[1]天津医科大学第二医院麻醉科,天津300211

出　　处：《天津医科大学学报》2016年第3期238-240,245,共4页Journal of Tianjin Medical University

摘　　要：目的：比较单用异丙酚或异丙酚复合依托咪酯诱导下不同性别罗库溴铵气管插管的半数有效剂量（ED50）。方法：择期拟行全身麻醉外科手术患者,年龄20-65岁,ASA分级I或II级,18 kg/m2〈BMI〈30 kg/m2,分为4组。采用靶控输注瑞芬太尼,设定效应室靶浓度5 ng/m L,P组（P1,P2）靶控输注异丙酚,设定血浆靶控浓度为3μg/m L;PE组（PE1,PE2）靶控输注异丙酚和依托咪酯,分别设定血浆靶控浓度为1.5μg/m L和0.3μg/m L。患者睫毛反射消失后,静注罗库溴铵,5 s内注射完毕,T1下降到0时,实施气管内插管。罗库溴铵试验剂量,男性组和女性组分别从0.29 mg/kg和0.24 mg/kg开始,各相邻剂量之间的比率为1.2。按序贯法进行试验,若患者试验结果不满意,下1名应用高1级剂量;否则,应用低1级剂量。试验满意的标准为气管插管条件Cooper’s评分为优。分别计算单用异丙酚或异丙酚复合依托咪酯麻醉诱导下中青年男性和女性罗库溴铵插管的ED50及其95%可信区间（95%CI）。结果：单用异丙酚诱导下中青年男性罗库溴铵插管的ED50及其95%CI为0.41（0.37-0.46）mg/kg;中青年女性罗库溴铵插管的ED50及其95%CI为0.32（0.29-0.34）mg/kg。异丙酚复合依托咪酯麻醉诱导下中青年男性和女性罗库溴铵插管的ED50及其95%CI分别为0.47（0.44-0.51）mg/kg和0.38（0.35-0.41）mg/kg,差异有统计学意义。结论：联合瑞芬太尼时,依托咪酯复合异丙酚的麻醉诱导比单用异丙酚时,需要更大剂量的罗库溴铵才能提供满意的插管条件。Objective： To compare the median dose（ED50） effect of rocuronium on rapid tracheal intubation following propofol or propofol combined with etomidate in male and female. Methods： ASA physical status I or II patients, aged 20-65 years, with body mass index of18-30 kg/m2, scheduled for elective operation under general anesthesia, were divided into 4 groups. Anesthesia was induced with targetcontrolled infusion of remifentanil with a target effect-site concentration of 5 ng/m L. P group patients received target controlled infusion of propofol with the target plasma concentration of 3.0 μg/m L;PE group patients received target controlled infusion of propofol and etomidate with the target plasma concentrations of 1.5 μg/m L and 0.3 μg/m L. When eyelash reflexes disappeared, apredetermined dose of rocuronium was administered in 5 s. The neuromuscular block was monitored until the T1（the first twitch in the TOF sequence from control） dropped to0,and then the tracheal catheter was inserted. The first male patient was given 0.29 mg/kg of rocuronium, and the female received 0.24mg/kg. The ratio of the two successive doses was 1.2. Modified Dixon＇s up-and-down method was used to determine the ED50 of rocuronium. Each time the dose of rocuronium decreased/increased in the next patient depending on whether the result was satisfactory.The satisfactory result was defined as excellent intubating condition. The ED50 and the 95% confidence interval of rocuronium for rapid tracheal intubation following propofol or propofol combined with etomidate in male and female were calculated. Results： The ED50（95% confidence interval）of rocuronium for rapid tracheal intubation following propofol in male and female were 0.41（0.37-0.46）mg/kg and 0.32（0.29-0.34）mg/kg. The ED50（95% confidence interval）of rocuronium for rapid tracheal intubation following propofol combined with etomidate in male and female were 0.47（0.44-0.51）mg/kg and 0.38（0.35-0.41）mg/kg. Conclusion： When combined with remifentanil, th

关 键 词：罗库溴铵 气管插管 半数有效剂量 异丙酚复合依托咪酯 异丙酚 

分 类 号：R614[医药卫生—麻醉学]