复合达克罗宁胶浆对丙泊酚麻醉下瑞芬太尼抑制老年患者喉罩置入反应的影响  

Effects of dyclonine gel on the remifentanil under propofol anesthesia to inhibit laryngeal mask insertion in elderly patients

作　　者：孙健[1] 孙建刚[1] SUN Jian;SUN Jian-gang(Department of Anesthesiology,The Second Hospital,Tianjin Medical University,Tianjin 300211,China)

机构地区：[1]天津医科大学第二医院麻醉科,300211

出　　处：《天津医科大学学报》2021年第1期52-54,69,共4页Journal of Tianjin Medical University

摘　　要：目的:测算复合达克罗宁胶浆时,丙泊酚麻醉下瑞芬太尼抑制老年患者喉罩置入反应的95%有效浓度(EC95)。方法:选择美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级,择期行喉罩全身麻醉手术老年患者80例,采用随机数字表法随机分成达克罗宁胶浆组(D组)和石蜡油组(C组)。麻醉诱导前2 min,D组嘱患者含服达克罗宁胶浆6 mL后可吞下,另将达克罗宁胶浆4 mL均匀涂抹于喉罩罩体两侧和背面;C组患者含服生理盐水,并用石蜡油涂抹喉罩。麻醉诱导采用靶控输注丙泊酚,血浆靶浓度3μg/mL,同时靶控输注瑞芬太尼,初始血浆靶浓度为1.5 ng/mL。当两者的血浆和效应室浓度平衡且BIS值<60时置入喉罩。按偏倚95%硬币的序贯设计,决定下1例瑞芬太尼血浆靶浓度:即如果上1例患者出现置罩反应,下1例患者上升一个等级;如果上1例未出现置罩反应,则下1例95%的概率留在同一等级,有5%的概率下降一个等级。相邻剂量组差值为0.5 ng/mL。发生喉罩置罩反应的标准:置入喉罩后出现体动、咳嗽、抵抗、喉痉挛和牙咬喉罩。EC95及其95%CI采用保序回归分析和Bootstrap测算。结果:靶控丙泊酚3μg/mL麻醉诱导下,D组瑞芬太尼抑制老年患者喉罩置入反应EC95为3.15 ng/mL,95%CI:2.48~3.42,C组瑞芬太尼抑制老年患者喉罩置入反应EC95为3.80 ng/mL,95%CI:3.44~3.95。结论:丙泊酚麻醉下,复合达克罗宁胶浆可降低瑞芬太尼抑制老年患者喉罩置入反应的血浆靶浓度。Objective:Comparison of the effect-site concentrations of remifentanil for laryngeal mask airway(LMA)insertion during target-controlled infusion of propofol with or without dyclonine gel.Methods:Eighty elderly patients with ASA gradeⅠ-Ⅱscheduled to undergo general laryngeal mask anaesthesia were randomly assigned to either the dyclonine gel group(C group)or paraffin oil group(D group).Two groups of patients were taken orally dyclonine gel or normal saline 6 mL before 2 minutes of induction of anesthesia,and the other 4 mL of dyclonine gel or paraffin oil was evenly applied to both sides and back of the laryngeal mask body respectively.Anesthesia was induced by target-controlled infusion(TCI)of propofol at a target plasma concentration of 3μg/mL,meanwhile remifentanil was administered by TCI at a target plasma concentration of 1.5 ng/mL for the first patient.When the target plasma and effect-site concentrations were balanced and bispectral index(BIS)was less than 60,then a laryngeal mask was inserted by the same anesthetist.The next effect-site concentration of remifentanil was given by biased coin design(BCD)using the up-and-down method.If the LMA insertion failed,the next patient in the assigned group received the next higher concentration of remifentanil.If the airway device was inserted successfully,the next patient in the same assigned group was randomized with a 0.95 probability to receive the same dose or a 0.05 probability to receive the next lower concentration using a 0.5 ng/mL step size.Airway device insertion was classified as′success′or′failure′based on patient response.The criteria of LMA reaction were body movement,cough,resistance,laryngospasm and tooth biting after laryngeal mask insertion.EC95 and its 95%CI were calculated by ordinal regression analysis and bootstrap.Results:During the anesthesia inducted by target-controlled propofol 3μg/mL,the EC95 of remifentanil inhibited LMA insertions in D group was 3.15 ng/mL,95%CI 2.49-3.42,and the EC95 of C group was 3.80 ng/mL,95%CI 3.44-3

关 键 词：丙泊酚 瑞芬太尼 喉罩 偏倚硬币设计保序回归 EC95 

分 类 号：R614.3[医药卫生—麻醉学]