瑞芬太尼在纤支镜经鼻清醒气管插管中最佳效应室浓度  

Optimal Effect-Site Concentration of Remifentanil for Awake Fibreoptic Nasotracheal Intubation in Patients

作　　者：周敏[1] 栾海星[1] ZHOU Min;LUAN Haixing(Department of Anesthesiology,First Hospital Affiliated to Xiamen University,Xiamen Fujian 361003,China)

机构地区：[1]厦门大学附属第一医院麻醉科

出　　处：《中国卫生标准管理》2019年第24期129-132,共4页China Health Standard Management

摘　　要：目的在择期颈椎外科手术中评估瑞芬太尼在纤支镜引导下经鼻清醒气管插管过程中的最佳效应室浓度EC95(使95%的患者平稳插管的效应室浓度)。方法ASA(美国麻醉医师协会)分级Ⅰ~Ⅱ的患者21例,应用Dixon序贯法和保序回归法测定瑞芬太尼平稳插管时的EC50(使50%的患者平稳插管的效应室浓度)和EC95。记录插管时间,不良反应和血液动力学变化。术后24 h随访患者对插管过程的记忆和满意度。结果瑞芬太尼效应室靶控浓度的EC50为(2.32±0.36)ng/m L;EC95为3.39(95%confidence interval 2.89~3.56)ng/m L。插管时间均数非平稳插管要比平稳插管长(6.2 vs.4.1,P<0.05)。12例(57.1%)患者能回忆插管过程,17例(81.0%)患者满意度评分良好。结论联合应用咪达唑仑和表麻剂地卡因下,清醒经鼻纤支镜引导气管插管的瑞芬太尼最佳效应室靶浓度(EC95)是3.39(95%CI 2.89~3.56)ng/mL。Objective To evaluated the optimal effect-s ite concentration(Ce)of remifentanil target-controlled infusion(TCI)for awake nasotracheal fibreoptic intubation in patients undergoing elective cervical spine surgery.Methods Twenty one ASA I~Ⅱpatients were enrolled.The EC50 and EC95 of remifentanil Ce for smooth intubation were determined using Dixon’s up-and-down method and isotonic regression.Intubation time,number of attempts,adverse events,and hemodynamic variables were also recorded.Patients were asked to recall the procedure and grade satisfaction at postoperative 24 h.Results The EC50 of remifentanil Ce for smooth intubation was(2.32±0.36)ng/mL as calculated by Dixon’s method.The estimated EC95 of remifentanil Ce was 3.39(95%confidence interval 2.89~3.56)ng/mL.Average intubation time(min)was longer in failed smooth intubation than in smooth intubation(6.2 vs.4.1,P<0.05).12 patients(57.1%)recalled the procedure and 17 patients(81.0%)rated their satisfaction score as good or excellent.Conclusion The estimated EC95 of remifentanil for smooth nasotracheal fibreoptic intubation with conscious sedation was 3.39(95%CI 2.89~3.56)ng/mL when used in combination with midazolam and topical dicaine.

关 键 词：瑞芬太尼 阿片类 纤支镜 清醒 气管插管 最佳效应室浓度 

分 类 号：R614[医药卫生—麻醉学]