靶控输注瑞芬太尼用于高强度超声聚焦疗法治疗子宫肌瘤的量效关系  

Dose-response relationship of remifentanyl given by target-controlled infusion for high-intensity focused ultrasound therapy in uterine myoma

作　　者：邹聪华[1,2] 陈烨[1,2] 郑晓春[1,2] 丁桂升[2,3] ZOU Cong-hua;CHEN Ye;ZHENG Xiao-chun;DING Gui-sheng(Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou 350001, China;Provincial Clinical Medical College, Fujian Medical University, Fuzhou 350001, China;Department of Ultrasonography, Fujian Provincial Hospital, Fuzhou 350001, China)

机构地区：[1]福建省立医院麻醉科,福州350001 [2]福建医科大学省立临床学院,福州350001 [3]福建省立医院超声科,福州350001

出　　处：《创伤与急诊电子杂志》2017年第4期181-184,共4页Journal of Trauma and Emergency(Electronic Version)

摘　　要：目的探讨单纯靶控输注(target-controlled infusion,TCI)瑞芬太尼用于高强度聚焦超声(high-intensity focused ultrasound,HIFU)治疗子宫肌瘤的量效关系。方法选择符合HIFU治疗标准的子宫肌瘤患者75例,年龄29~55岁,ASA(American Association of Anesthesiologists)评级均为Ⅰ~Ⅱ级。根据瑞芬太尼的血浆靶浓度,采用随机数字表法将75例患者分为5组,每组15例:1μg/L(R_1组)、1.5μg/L(R_2组)、2μg/L(R_3组)、2.5μg/L(R_4组)、3μg/L(R_5组)。所有患者术前均未用药并详细告知患者VAS评分(0~10分)的使用,确保每一位患者都能熟练使用VAS评分。理想的瑞芬太尼血浆靶浓度定义:无低氧血症、呼吸抑制、呼吸暂停出现且整个过程中0分<VAS评分<3分(或在术中出现VAS≥4分,但仅调整HIFU治疗位置后VAS下降到0分<VAS评分<3分),无需调整剂量或追加其他镇痛药物。记录术前、TCI后5分钟、TCI后10分钟、TCI后1h及术毕的血氧饱和度、呼吸频率;记录T_0~T_4患者的VAS评分,有无下肢放射痛、不能忍受的烧灼感、头晕、恶心、呕吐;记录每组患者靶控浓度达到理想血浆靶浓度的例数,采用Probit概率法计算50%和95%的患者TCI泵入的理想血浆靶浓度(ED_(50)和ED_(95))。结果瑞芬太尼TCI泵入用于HIFU治疗子宫肌瘤的理想血浆靶浓度ED_(50)为1.7μg/L(95%CI 1.3~1.8μg/L),ED_(95)为2.2μg/L(95%CI1.9~2.4μg/L)。5例出现一过性单侧下肢疼痛,停止治疗后即刻消失。治疗区腹壁皮肤灼热感8例,停止治疗或移动治疗探头位置后消失,均无头晕、恶心、呕吐发生。结论瑞芬太尼用于HIFU治疗子宫肌瘤镇痛效果好且可控性强,安全可靠。Objective To determine the dose-response relationship of remifentanyl given by target-controlled infusion（TCI）for high-intensity focused ultrasound（HIFU）therapy in uterine myoma.Methods Seventy-five ASA physical status Ⅰor Ⅱ patients with uterine myoma,aged29-55 years,scheduled for high-intensity focused ultrasound treatment,were randomly divided into 5 groups of 15 participants in each from R_1 to R_5 using a random number table.In R_1,R_2,R_3,R_4 and R_5 groups,target plasma concentrations were entered into the pump at 1,1.5,2,2.5 and3μg/L,respectively.All patients with a good command of visual analogue scale were not given any medication before operation,and the VAS score（0~10 score）was used to inform the patients in detail.An ideal target plasma concentration was defined as no hyoxemia,no respiratory depression,no apnea and VAS≤3 or VAS dropped to 0~3 when the locus of HIFU was changed,and there was no need to change the dosage or use any analgesics during the treatment.Pulse oxygen saturation,RR,VAS score were assessed and scored using VAS scale before and at2,4,6,8 and 10 min after drug administration of TCI.Besides one sided leg pain,skin burning,dizzy,vomit and nausea were also monitored.The number of cases of ideal remifentanyl target plasma concentrations was recorded.The ED_（50） and ED_（95） of the ideal remifentanyl target plasma concentrations were calculated by Probit probability method.Five patients had transient one sided leg pain which disappeared after the end of treatment.Eight patients had skin burning which disappeared after the treatment ended or the probe was moved.No dizziness,nausea or vomiting occurred to the patients.Results ED_（50） and ED_（95） of remifentanyl target plasma concentrations for HIFU treatment were 1.7μg/L（95%CI 1.3~1.8μg/L）and 2.2μg/L（95%CI1.9~2.4μg/L）,respectively.Conclusion Remifentanyl given by TCI for high-intensity focused ultrasound therapy in uterine myoma is effective,feasible,safe and reliable.

关 键 词：瑞芬太尼 高强度超声聚焦疗法 量效关系 

分 类 号：R614[医药卫生—麻醉学] R737.33[医药卫生—外科学]