BCD法测定瑞马唑仑复合依托咪酯全麻诱导的有效剂量  

Effective dose of remimazolam combined with etomidate for general anesthesia induction by BCD method

作　　者：陈锦明 程晓磊 孙浩[2] 莫桂熙 Chen Jinming;Cheng Xiaolei;Sun Hao;Mo Guixi(Department of Anesthesiology,Affiliated Hospital of Guangdong Medical University,Zhanjiang 524023,China;Department of Anesthesiology,Shunde Hospital of Jinan University,Foshan 528305,China)

机构地区：[1]广东医科大学附属医院麻醉科,湛江524023 [2]暨南大学附属顺德医院麻醉科,佛山528035

出　　处：《国际医药卫生导报》2024年第11期1791-1796,共6页International Medicine and Health Guidance News

基　　金：广东省自然科学基金(2021A1515011033)。

摘　　要：目的采用抛偏倚银币(BCD)法分阶段测定瑞马唑仑复合依托咪酯全麻诱导的半数有效剂量(ED_(50))及95%有效剂量(ED_(95))。方法选取广东医科大学附属医院2022年9月1日至2023年10月31日收治的拟行气管插管全身麻醉手术患者104例,年龄18~64岁,分两个阶段(S1组和S2组)进行BCD法试验。S1组设定依托咪脂诱导剂量固定值为0.15mg/kg,首例患者给予瑞马唑仑0.25mg/kg,当患者麻醉后意识消失,警觉/镇静评分(OAA/S评分)≤1分且脑电双频指数(BIS)≤60时,给予顺阿曲库铵0.2 mg/kg和舒芬太尼0.4μg/kg,根据患者气管插管后心血管反映情况,采用BCD法测定瑞马唑仑的ED_(50)、ED_(95);同理,S2组固定瑞马唑仑ED_(50)剂量,测定依托咪酯的ED_(50)、ED_(95)。记录患者气管插管过程[麻醉诱导前(T0)、插管前(T1)、插管后1 min(T2)和插管后3 min(T3)]的心血管反应情况,记录给药后患者发生低血压、心动过缓、肌颤、呃逆及注射痛等不良反应情况。采用重复测量方差分析、χ^(2)检验、Fisher精确概率,根据患者用药剂量,用Probit概率单位法计算有效剂量值及95%可信区间(CI)。结果S1组试验患者52例,男21例,女31例,年龄(40.7±12.2)岁,体质量指数(BMI)为(22.8±3.1)kg/m^(2),美国麻醉医师协会(ASA)分级Ⅰ级11例,Ⅱ级41例;S2组试验患者52例,男27例,女25例,年龄(39.7±12.7)岁,BMI(22.4±2.8)kg/m^(2),ASAⅠ级3例,Ⅱ级49例。复合依托咪酯(0.15 mg/kg)全麻诱导时,瑞马唑仑抑制气管插管心血管反应的ED_(50)为0.253 mg/kg(95%CI 0.130~0.265 mg/kg),ED_(95)为0.285mg/kg(95%CI0.276~0.352mg/kg);复合瑞马唑仑(0.25mg/kg)全麻诱导时,依托咪酯抑制气管插管心血管反应的ED_(50)为0.191 mg/kg(95%CI 0.084~0.212 mg/kg),ED_(95)为0.254 mg/kg(95%CI 0.234~0.413 mg/kg)。S1组及S2组T0、T1、T3时的心率(HR)比较差异均无统计学意义(均P>0.05);与T0比较,T2时HR均加快(均P<0.05);T0和T2时的平均动脉压(MAP)高于T1和T3时,差异均有统�Objective To determine the median and 95 percent effective doses(ED_(50) and ED_(95))of remimazolam combined with etomidate for general anesthesia induction by the biased coin design(BCD)method in two stages.Methods One hundred and four patients taking general anesthesia by tracheal intubation at Affiliated Hospital of Guangdong Medical University from September 1,2022 to October 31,2023 were selected,and were divided in two stages(group S1 and group S2)for the BCD experiment;they were 18-64 years old.In group S1,the fixed dose of etomidate was set as 0.15 mg/kg;the first patient was given remimazolam 0.25 mg/kg;when the patient was not conscious,the score of alertness/sedation(OAA/S)≤1,and bispectral index(BIS)≤60,the patient was given sufentanil 0.4μg/kg and atracurium 0.2 mg/kg;the ED_(50) and ED_(95) of remimazolam for the next patient were determined by the BCD method based on the situation of tracheal tube insertion in the previous patient.Similarly,the ED_(50) of remimazolam was fixed in group S2,and the ED_(50) and ED_(95) of etomidate were measured.The cardiovascular response to tracheal intubation before induction(T0)and before(T1)and 1(T2)and 3 min(T3)after intubation and the incidences of hypotension,bradycardia,muscle tremors,hiccup,injection pain,etc.were recorded.The repeated measurement analysis of variance,χ^(2) test,and Fisher exact probability were applied.According to the dosage of medication,the effective dose and 95%confidence interval(CI)were calculated by the Probit probability unit method.Results There were 52 cases in group S1,including 21 males and 31 females;they were(40.7±12.2)years old;their body mass index(BMI)was(22.8±3.1)kg/m2;there were 11 cases of gradeⅠand 41 cases of gradeⅡof American Society of Anesthesiologists(ASA).There were 52 cases in group S2,including 27 cases and 25 cases;they were(39.7±12.7)years old;their BMI was(22.4±2.8)kg/m2;there were 3 cases of gradeⅠand 49 cases of gradeⅡof ASA.When 0.15 mg/kg etomidate was used for the general anesthesia ind

关 键 词：气管插管 抛偏倚银币法 瑞马唑仑 依托咪脂 量效关系 有效剂量 

分 类 号：R614[医药卫生—麻醉学]