利福平的肝药酶诱导作用对右美托咪定麻醉效果的影响  

Effects of rifampicin liver enzyme induction on anesthetic efficacy of dexmedetomidine

作　　者：何婉雯 温海明[1] 代冬梅[1] 孔德煜 邵琤 连贵勇[1] 郭瑞 HE Wan-wen;WEN Hai-ming;DAI Dong-mei;KONG De-yu;SHAO Zheng;LIAN Gui-yong;GUO Rui(Department of Anesthesiology,Guangzhou Chest Hospital,Guangzhou GUANGDONG 510095,China;Department of Anesthesiology,the Fifth Affiliated Hospital of Guangzhou Medical University,Guangzhou GUANGDONG 510700,China)

机构地区：[1]广州市胸科医院麻醉科,广东广州510095 [2]广州医科大学附属第五医院麻醉科,广东广州510700

出　　处：《中国新药与临床杂志》2021年第11期760-763,共4页Chinese Journal of New Drugs and Clinical Remedies

基　　金：广州市卫生健康科技项目(20201A010026)。

摘　　要：目的观察利福平的肝药酶诱导作用对右美托咪定麻醉效果的影响。方法选择拟行肺大疱手术患者40例设为对照组,经利福平治疗9~12个月拟行结核性肺纤维板剥脱术患者40例设为观察组。2组均采用全身麻醉,右美托咪定0.2μg·kg^(-1)·h^(-1)静脉输注10 min后进行麻醉诱导,气管插管成功后予1.7%七氟烷吸入,瑞芬太尼0.2μg·kg^(-1)·min^(-1)、右美托咪定0.2μg·kg^(-1)·h^(-1)静脉维持。采用序贯法测定右美托咪定抑制插管应激反应的半数有效剂量(EC_(50))及其95%置信区间(CI)。观察2组平均动脉压(MAP)和心率(HR),并检测血促肾上腺皮质激素(ACTH)和皮质醇(COR)水平。结果对照组右美托咪定抑制插管应激反应的EC_(50)(95%CI)为0.246μg·kg^(-1)·h^(-1)(0.227~0.266μg·kg^(-1)·h^(-1)),观察组为0.332μg·kg^(-1)·h^(-1)(0.310~0.358μg·kg^(-1)·h^(-1)),观察组显著高于对照组(P=0.0001)。插管时、插管后5 min、切皮时、术毕、苏醒期观察组ACTH、COR、MAP和HR均较诱导前显著升高(P<0.05),且高于同时点对照组值(P<0.05)。结论利福平可引起右美托咪定麻醉效果下降,进而减弱右美托咪定消除应激的效能,增加使用耐量。AIM To observe the effects of rifampicin liver enzyme induction on the anesthetic efficacy of dexmedetomidine.METHODS Forty patients undergoing pulmonary bullae surgery were enrolled as the control group,and 40 tuberculosis patients undergoing stripping of pulmonary fibreboard operation after 9 to 12 months treatment of rifampicin were selected as the observation group.General anesthesia was used in both groups.Dexmedetomidine 0.2μg·kg^(-1)·h^(-1)was infused for 10 minutes and then anesthesia was induced.After successful endotracheal intubation,1.7%sevoflurane,remifentanil 0.2μg·kg^(-1)·min^(-1) and dexmedetomidine 0.2μg·kg^(-1)·h^(-1) were given for anesthesia maintenance.The median effective concerntration (EC_(50))and its 95%confidence interval (CI) of dexmedetomidine which inhibiting intubation stress response were determined by the up-and-down sequential method.The levels of mean arterial pressure(MAP),heart rate (HR) were observed.The adrenocorticotropic hormone (ACTH) and cortisol (COR) were detected in both groups.RESULTS The EC_(50) of dexmedetomidine was 0.246μg·kg^(-1)·h^(-1) (95%CI:0.227 to 0.266μg·kg^(-1)·h^(-1))in the control group and 0.332μg·kg^(-1)·h^(-1) (95%CI:0.310 to 0.358μg·kg^(-1)·h^(-1))in the observation group.The EC_(50) of dexmedetomidine in the observation group was significantly higher than that in the control group(P=0.000 1).Compared with those before anesthesia induction,the levels of ACTH,COR,MAP and HR at intubation,5 minutes after intubation,skin incision,end of operation,awakening period were significantly increased in the observation group (P<0.05).And these indexes in the observation group were significantly higher than those in the control group at each observation point (P<0.05).CONCLUSION Rifampicin may decrease the anesthetic efficacy of dexmedetomidine,thus reducing the stress elimination effect of dexmedetomidine and increasing the tolerance to use.

关 键 词：利福平 右美托咪定 肝 酶诱导 细胞色素P450酶诱导剂 

分 类 号：R971[医药卫生—药品]