复合右美托咪定时瑞芬太尼抑制甲状腺手术患者无肌松气管插管反应的量效关系  

Dose-effect relationship of remifentanil inhibiting responses to endotracheal intubation without neuromuscular relaxant when combined with dexmedetomidine in patients undergoing thyroid surgery

作　　者：冯磊[1] 刘建[1] 华伟[1] 韩莹 孙熠[1] 赵茗姝[1] 王海云[1] Feng Lei;Liu Jian;Hua Wei;Han Ying;Sun Yi;Zhao Mingshu;Wang Haiyun(Department of Anesthesiology,The Third Central Hospital of Tianjin Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases Tianjin Artificial Cell Engineering Technology Research Center Tianjin Institute of Hepatobiliary Disease,Tianjin 300170,China)

机构地区：[1]天津市第三中心医院麻醉科,天津市重症疾病体外生命支持重点实验室,天津市人工细胞工程技术研究中心,天津市肝胆疾病研究所,300170

出　　处：《中华麻醉学杂志》2021年第6期735-737,共3页Chinese Journal of Anesthesiology

摘　　要：目的:确定复合右美托咪定时瑞芬太尼抑制甲状腺手术患者无肌松气管插管反应的半数有效剂量(ED_(50))和95%有效剂量(ED_(95))。方法:择期行术中神经监测下甲状腺手术患者,性别不限,年龄18~64岁,ASA分级Ⅰ或Ⅱ级,体重指数18~28 kg/m^(2)。麻醉诱导前10 min时静脉注射右美托咪定负荷剂量0.8μg/kg。麻醉诱导:静脉注射咪达唑仑0.1 mg/kg、依托咪酯0.4 mg/kg和预定剂量瑞芬太尼。采用Dixon序贯法确定瑞芬太尼剂量,初始剂量为3.7μg/kg,根据气管插管反应确定下一例瑞芬太尼剂量,相邻剂量的比为1.1,采用Probit法计算ED_(50)、ED_(95)及其95%可信区间。结果:复合右美托咪定麻醉诱导时,瑞芬太尼行无肌松插管反应的ED_(50)及其95%可信区间分别为3.39(3.29~3.50)μg/kg,ED_(95)及其95%可信区间分别为3.52(3.48~3.64)μg/kg。结论:复合右美托咪定时,瑞芬太尼抑制甲状腺手术患者无肌松气管插管反应的ED_(50)为3.39μg/kg,ED_(95)为3.52μg/kg。Objective To determine the median effective dose(ED_(50))and the 95%effective dose(ED_(95))of remifentanil inhibiting responses to endotracheal intubation without neuromuscular relaxant when combined with dexmedetomidine in patients undergoing thyroid surgery.Methods American Society of Anesthesiologists physical statusⅠorⅡpatients of either sex,aged 18-64 yr,with body mass index of 18-28 kg/m^(2),scheduled for elective thyroid surgery under intraoperative neuromonitoring,were enrolled in this study.Dexmedetomidine was intravenously injected in a loading dose of 0.8μg/kg at 10 min before anesthesia induction.Anesthesia was induced by intravenously injecting midazolam 0.1 mg/kg,etomidate 0.4 mg/kg and the preset dose of remifentanil.The dose of remifentanil was determined using up-and-down sequential method.The initial dose was set at 3.7μg/kg.The dose of remifentanil in the next case was determined according to whether responses to endotracheal intubation occurred,and the ratio between the two successive doses was 1.1.The ED_(50),ED_(95) and 95%confidence interval(CI)were calculated by Probit analysis.Results when combined with dexmedetomidine for anesthesia induction,the ED_(50)(95%CI)of remifentanil inhibiting responses to endotracheal intubation without neuromuscular relaxant was 3.39(3.29-3.50)μg/kg,and the ED_(95)(95%CI)was 3.52(3.48-3.64)μg/kg.Conclusion when combined with dexmedetomidine,the ED_(50) of remifentanil inhibiting responses to endotracheal intubation without neuromuscular relaxant is 3.39μg/kg,and the ED_(95) is 3.52μg/kg.

关 键 词：右美托咪啶 哌啶类 剂量效应关系 药物 插管法 气管内 

分 类 号：R614[医药卫生—麻醉学]