3 min靶控全麻诱导插管依托咪酯血浆浓度与瑞芬太尼血浆浓度最佳配伍剂量观察  

Observation on the Best Compatible Dose of Etomidate Plasma Concentration and Remifentanil Plasma Concentration in 3-Minute Target Controlled General Anesthesia Induction

作　　者：邝永燕 石琦 肖腾 袁承城[1] 康力[1] 王珊 刘华[1] KUANG Yong-yan;SHI Qi;XIAO Teng;YUAN Cheng-cheng;KANG Li;WANG Shan;LIU Hua(Department of Anesthesiology,Bao'an District Hospital of Traditional Chinese Medicine of Shenzhen City in Guangdong Province,Shenzhen 518133)

机构地区：[1]广东省深圳市宝安区中医院麻醉科,深圳518133

出　　处：《实用中西医结合临床》2022年第9期93-97,共5页Practical Clinical Journal of Integrated Traditional Chinese and Western Medicine

基　　金：广东省深圳市宝安区科技局2019年科研基金(编号:2019JD351)。

摘　　要：目的:探索寻找使用TCI注射泵实施3 min靶控全麻诱导的依托咪酯血浆浓度(Cp)与瑞芬太尼Cp配伍大组中抑制插管反应效果最好又无或少副作用的最佳药物浓度、配伍剂量组合。方法:选取择期实施骨科、普外科、妇科手术接受气管插管全麻的美国麻醉医师协会(ASA)分级Ⅰ级或Ⅱ级中青年患者150例,随机分为:依托咪酯Cp 1.0μg/ml、1.1μg/ml、1.2μg/ml、1.4μg/ml、1.5μg/ml分别与瑞芬太尼Cp 20 ng/ml配伍组,共5组,每组30例。先静注阿托品0.007 mg/kg,心率上升后启动TCI泵并开始计时,意识消失时静注罗库溴铵0.8 mg/kg,在TCI泵注3 min时使用Airtraq和Insighters可视喉镜气管插管。记录患者基础和插管前后平均动脉压(MAP)和心率(HR)等数据。结果:5组中,瑞芬太尼Cp 20 ng/ml配伍依托咪酯Cp 1.0μg/ml组抑制插管反应效果Ⅱ级,肌颤、肌僵发生率为零。结论:瑞芬太尼Cp 20 ng/ml配伍依托咪酯Cp 1.0μg/ml组抑制插管反应效果Ⅱ级,肌颤、肌僵发生率为零,是中青年患者使用TCI注射泵实施3 min靶控全麻诱导抑制插管反应效果最好的组,是安全的最佳药物浓度配伍剂量组合。Objective:To explore the best drug concentration and compatibility dose combination of etomidate plasma concentration(Cp)and remifentanil Cp in the large group induced by 3-minute target controlled general anesthesia with TCI injeetion pump,which has the best effect of inhibiting intubation reaction without or less side effects.Methods:A total of 150 young and middle-aged patients of grade Ⅰ or Ⅱ according to American society of Anesthesiologists(ASA)who underwent endotracheal intubation general anesthesia in orthopaedics,general surgery and gynecological surgery were selected,they were randomly divided into five groups:etomidate Cp 1.0μg/ml,1.1μg/ml,1.2μg/ml,1.4μg/ml,and 1.5μg/ml in combination with remifentanil Cp 20 ng/ml each,with 30 cases in each group.Atropine 0.007 mg/kg was injected intravenously,TCI pump was started and timing was started after heart rate rose,rocuronium 0.8 mg/kg was injected intravenously when consciousness disappeared,and Airtraq and Insighters visual laryngoscope were used for endotracheal intubation 3 min after TCI pump injection.Recorded the patient's baseline,mean arterial pressure(MAP)and heart rate(HR)before and after intubation.Results:Among the five groups,remifentanil Cp 20 ng/ml combined with etomidate Cp 1.0μg/ml had gradeⅡeffect on inhibiting intubation response,and the incidence of muscle fibrillation and muscle stiffness was 0.Conclusion:The effect of remifentanil Cp 20 ng/ml combined with etomidate Cp 1.0μg/ml on inhibiting intubation response is gradeⅡ,and the incidence of muscle fibrillation and muscle stiffness is 0.It is the best group for young and middle-aged patients to use TCI injection pump to implement 3-minute target controlled general anesthesia induction to inhibit intubation response,and it is the best combination of safe drug concentration and dose.

关 键 词：3 min靶控全麻诱导 依托咪酯 瑞芬太尼 血浆浓度 配伍剂量 

分 类 号：R614.2[医药卫生—麻醉学]