复合咪达唑仑-依托咪酯时阿芬太尼抑制老年患者喉罩置入心血管反应的量效关系  

Dose-response relationship of alfentanil in combination with midazolam-etomidate inhibiting cardiovascular responses to laryngeal mask airway implantation in elderly patients

作　　者：马凤丹 姜卜维 张珈硕 黄瑾 杨明玉 杨洋[1,2] 王曼 马永利[1] 陈娜[1] 王春光[1] Ma Fengdan;Jiang Bowei;Zhang Jiashuo;Huang Jin;Yang Mingyu;Yang Yang;Wang Man;Ma Yongli;Chen Na;Wang Chunguang(Department of Anesthesiology,Baoding First Central Hospital,Baoding 071000,China;Graduate School of Chengde Medical College,Chengde 067000,China;Graduate School of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]保定市第一中心医院麻醉科,保定071000 [2]承德医学院研究生学院,承德067000 [3]河北医科大学研究生学院,石家庄050000

出　　处：《中华麻醉学杂志》2022年第11期1306-1309,共4页Chinese Journal of Anesthesiology

摘　　要：目的:评价复合咪达唑仑-依托咪酯时阿芬太尼抑制老年患者喉罩置入心血管反应的量效关系。方法:择期全身麻醉下手术老年患者,性别不限,年龄65~85岁,BMI 20~30 kg/m^(2),ASA分级Ⅰ或Ⅱ级。静脉注射咪达唑仑0.025 mg/kg,给予患者充分镇静,5 min后连续记录3次MAP和HR,间隔3 min,取其平均值作为基础值。静脉注射依托咪酯0.2 mg/kg,待BIS值<60时依次静脉注射阿芬太尼、罗库溴铵0.6 mg/kg,静脉注射阿芬太尼后1.4 min时置入喉罩,行机械通气。采用Dixon序贯法进行试验,阿芬太尼初始剂量设定为6.83μg/kg,发生喉罩置入心血管反应,下一例患者升高1个剂量梯度,未发生喉罩置入心血管反应,降低1个剂量梯度,相邻剂量比值为1.0∶1.1。发生喉罩置入心血管反应的标准:喉罩置入后2 min内MAP最大值或HR最大值较基础值增加≥20%。采用Probit法计算阿芬太尼抑制老年患者喉罩置入心血管反应的半数有效剂量(ED_(50))、95%有效剂量(ED_(95))及其95%可信区间(95%CI)。结果:复合咪达唑仑-依托咪酯时阿芬太尼抑制老年患者喉罩置入心血管反应的ED_(50)及其95%CI为5.605(5.036~6.082)μg/kg,ED_(95)及其95%CI为6.625(6.125~9.763)μg/kg。结论:复合咪达唑仑-依托咪酯时阿芬太尼抑制老年患者喉罩置入心血管反应的ED_(50)和ED_(95)分别为5.605和6.625μg/kg。Objective To evaluate the dose-response relationship of alfentanil in combination with midazolam-etomidate inhibiting cardiovascular responses to laryngeal mask airway implantation in elderly patients.Methods American Society of Anesthesiologists Physical StatusⅠorⅡpatients of either sex,aged 65-85 yr,with body mass index of 20-30 kg/m^(2),undergoing elective operation under general anesthesia,were enrolled in this study.Midazolam 0.025 mg/kg was intravenously injected for adequate sedation,5 min later mean arterial pressure and heart rate were recorded for 3 consecutive times at 3-min interval,the mean value was collected and considered as the baseline value.Etomidate 0.2 mg/kg was intravenously injected,and alfentanil and rocuronium 0.6 mg/kg were intravenously injected when bispectral index value<60.A laryngeal mask airway was inserted at 1.4 min after intravenous injection of alfentanil,and mechanical ventilation was performed.The dose of alfentanil was determined by the Dixon′s up-and-down method.The initial dose of alfentanil was set at 6.83μg/kg.The dose of alfentanil in the next patient was determined according to the development of cardiovascular response to laryngeal mask airway placement.If the cardiovascular response to laryngeal mask airway placement occurred,the dose was increased for the next patient,and if cardiovascular response to laryngeal mask airway placement did not occur,the dose was decreased,and the ratio between the two successive doses was 1.0∶1.1.The cardiovascular response to laryngeal mask airway placement was defined as increase in maximum mean arterial pressure or maximum heart rate by≥20%of baseline values within 2 min after laryngeal mask airway placement.The median effective dose(ED50),95%effective dose(ED_(95))and 95%confidence interval(95%CI)of alfentanil inhibiting cardiovascular responses to laryngeal mask airway placement in elderly patients were calculated by the Probit method.Results When combined with midazolam and etomidate,the ED_(50)(95%CI)of alfentanil inh

关 键 词：阿芬太尼 咪达唑仑 依托咪酯 喉罩 老年人 心血管反应 剂量效应关系 药物 

分 类 号：R614[医药卫生—麻醉学]