瑞芬太尼抑制老年患者腹腔镜气腹循环反应半数有效浓度的观察  

Minimum effective concentration of Remifentanil in inhibiting laparoscopic pneumoperitoneal circulation in elderly patients

作　　者：刘邵华[1] 邵刘佳子[1] 薛富善 魏威[1] 冯璐 田鸣[1] LIU Shao-hua;SHAO Liu-jiazi;WEI Fu-shan(Department of Anesthesiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院麻醉科

出　　处：《临床和实验医学杂志》2019年第15期1678-1680,F0003,共4页Journal of Clinical and Experimental Medicine

基　　金：吴阶平基金(编号:320.6750.18192)

摘　　要：目的观察老年患者腹腔镜手术中抑制气腹时循环反应所需的瑞芬太尼半数有效浓度。方法前瞻性研究,选择2018年10月至2019年5月首都医科大学附属北京友谊医院收治的拟择期行腹腔镜结肠手术的患者25例,年龄65~80岁,ASAⅠ~Ⅱ级。所有患者靶控输注丙泊酚,血浆靶浓度为3.5μg/ml,意识消失后给予罗库溴铵0.9 mg/kg,2 min后置入喉罩,于手术开始前血浆靶控输注瑞芬太尼,按序贯法确定瑞芬太尼浓度,若前1例患者气腹后5 min内平均动脉压(MAP)和(或)心率(HR)与气腹前相比升高>20%,则当前患者应用高一级浓度;若前1例患者气腹后5min内MAP和(或)HR与气腹前相比升高<20%,则当前患者应用低一级浓度,相邻效应室靶浓度比为1.2︰1。用序贯法计算能够抑制50%的老年患者腹腔镜气腹后血流动力学波动的瑞芬太尼靶控输注血浆半数有效浓度(EC50)。结果用序贯法计算得到的瑞芬太尼抑制老年患者腹腔镜气腹血流动力学反应的EC50为2.67 ng/ml,其95%CI为2.61~2.72 ng/ml。结论与丙泊酚联合靶控输注时,瑞芬太尼血浆靶浓度为2.67 ng/ml可以抑制50%老年患者腹腔镜气腹所引起的循环波动。Objective To determine the minimum effective concentration(EC50)of Remifentanil blunting the hemodynamic response to pneumoperitoneum pressure in elderly patient with propofol anesthesia.Methods This prospective study enrolled 25 healthy elderly patients(ASA statusⅠ~Ⅱ),aged 65-80 scheduled for laparoscopic surgery during October 2018 and May 2019 in Beijing Friendship Hospital.Propofol was given through target-controlled infusion(TCI)with the concentration of 3.5μg/ml to the patients.When they lost consciousness 0.9 mg/kg rocuronium was administrated and laryngeal mask was inserted 2 minutes later.Remifentanil was given with plasma TCI before surgery.The"up-and-down"sequential allocation method was used for determining the concentration of remifentanil.When a patient showed an increase of either heart rate or mean arterial blood pressure(MAP)>20%from the nonpneumoperitoneum value,the plasma concentration of remifentanil given to the next patient was increased(positive response).In the absence of either heart rate or MAP increasing>20%from nonpneumoperitoneum value the plasma concentration given to the next patient was decreased(negative response).The ratio of two close plasma concentration was 1.2:1.EC50 of remifentanil blunting the hemodynamic response to pneumoperitoneum pressure was calculated with The"up-and-down"sequential allocation method.Results From the"up-and-down"method,the EC50 of Remifentanil blunting the hemodynamic response to pneumoperitoneum pressure was 2.67 ng/ml,95%CI ranged from 2.61~2.72 ng/ml.Conclusion Plasma concentrations of Remifentanil of 2.67 ng/ml is effective in blunting hemodynamic response to pneumoperitoneum pressure in 50%of elderly patients when combined with a target controlled infusion of propofol.

关 键 词：老年人 腹腔镜手术 瑞芬太尼 气腹循环反应 半数有效浓度 

分 类 号：R614[医药卫生—麻醉学]