Narcotrend监测下序贯法测定丙泊酚抑制小儿气管插管反应的半数有效剂量  

Determination of median effective dose of propofol for inhibiting tracheal intubation response in children by sequential experimental method under Narcotrend monitoring

作　　者：张春元[1] 谭美云[1] 曾伟[1] ZHANG Chunyuan;TAN Meiyun;ZENG Wei(Zhongshan Boai Hospital,Zhongshan 528400,Guangdong,China)

机构地区：[1]中山市博爱医院,广东中山528400

出　　处：《新疆医学》2021年第10期1129-1132,1128,共5页Xinjiang Medical Journal

基　　金：中山市社会公益与基础研究(项目编号:2021SYF01)。

摘　　要：目的Narcotrend(NT)监测下序贯法测定丙泊酚抑制小儿气管插管反应的半数有效剂量(Median Effective Dose,ED_(50))及95%的可信区间(95%CI)。方法选择择期手术患儿25例,1-3岁,ASAⅠ或Ⅱ级。在NT监测下采用不同剂量的丙泊酚复合固定剂量的瑞芬太尼及维库溴铵进行全麻诱导插管。丙泊酚诱导剂量按序贯法原则根据插管反应进行增减给药,初始剂量为2 mg/kg,相邻剂量对数梯度为0.1。插管反应标准:插管后MAP或HR的均值较插管前基础值上升幅度≥10%,为插管反应阳性(+),反之,则为插管反应阴性(-)。依次试验,从阳性到阴性或从阴性到阳性,出现6个交叉点后停止试验。采用Dixon and Massey序贯分配试验法公式计算丙泊酚ED_(50)及95%CI。结果所有患儿插管后NT、HR、MAP均有不同程度的增高,上升幅度与剂量呈负相关,抑制插管反应效应与剂量呈正相关,丙泊酚ED_(50)为2.23(1.96,2.54)mg/kg。结论在完善的镇痛和肌松作用下,达到意识消失的丙泊酚诱导剂量不能充分抑制插管反应,存在隐记忆发生风险,选择最小有效剂量可参考丙泊酚ED_(50)2.23(1.96,2.54)mg/kg,应用Narcotrend监测可进一步指导并优化临床用药。Objective The Median Effective Dose(ED_(50))and 95%confidence interval(95%CI)of propofol in inhibiting tracheal intubation response in children were determined by sequential method under Narcotrend(NT)monitoring.Methods Twenty-five children undergoing surgery were selected,aged 1-3 years with the ASA physical statusⅠorⅡ.Different doses of propofol combined with fixed doses of remifentanil and vecuronium bromide were used for general anesthesia induction intubation under NT monitoring.Propofol induced dose was increased or decreased according to the intubated response,the initial dose of 2 mg/kg,the logarithmic gradient of adjacent dose was fixed at 0.1.The standard of the intubation reaction:if the average value of MAP or HR after intubation was increased by greater than or equal to 10%based on the value before intubation,the intubation reaction was positive(+),otherwise,the intubation reaction was negative(-).Test in sequence,from positive to negative or from negative to positive,stop test after 6 crossing points.Dixon and Massey sequential distribution test formula was used to calculate propofol ED_(50) and 95%CI.Results The NT、HR、MAP of all the children were increased in varying degrees after intubation,the increase was negatively correlated with the dose,the effect of inhibition of intubation response was positively correlated with the dose,the ED_(50) of propofol was 2.23 mg/kg and 95%CI(1.96,2.54).Conclusion The dose of propofol only satisfy to disappearance of consciousness can’t fully inhibit the intubation response under the action of complete analgesia and muscle relaxation,and there is a risk of hidden memory occurrence.Choose the minimum effective dose reference propofol ED_(50) 2.23(1.96,2.54)mg/kg,application Narcotrend monitoring can further guide and optimize clinical medication.

关 键 词：Narcotrend监测 丙泊酚ED50 小儿手术 插管反应 

分 类 号：R614[医药卫生—麻醉学]