性别因素对羟考酮抑制患者喉罩置入反应效力的影响  

Effect of gender factors on potency of oxycodone inhibiting responses to laryngeal mask airway insertion in patients

作　　者：胡春华 赵晓艳[1] 王惠军[1] 吴黎黎[1] 王茜[1] 王古岩 Hu Chunhua;Zhao Xiaoyan;Wang Huijun;Wu Lili;Wang Qian;Wang Guyan(Department of Anesthesiology,Beijing Tongren Hospital,Capital Medical University,Beijing 100176,China)

机构地区：[1]首都医科大学附属北京同仁医院麻醉科,北京100176

出　　处：《中华麻醉学杂志》2024年第5期584-586,共3页Chinese Journal of Anesthesiology

基　　金：北京市医院管理中心临床医学发展专项经费资助(ZYLX202103)。

摘　　要：目的评价性别因素对羟考酮抑制患者喉罩置入反应效力的影响。方法拟行喉罩全身麻醉下择期手术患者,年龄18~59岁,ASA分级Ⅰ或Ⅱ级,BMI 18~28 kg/m^(2),根据性别分为男性组(M组)和女性组(F组)。采用改良Dixon序贯法进行研究,每组首例患者静脉注射羟考酮0.10 mg/kg,同时靶控输注丙泊酚血浆靶浓度3μg/ml,效应室浓度与血浆浓度平衡后,脑电双频指数(BIS)≤60时静脉注射顺式阿曲库铵0.2 mg/kg,3 min后置入喉罩。若喉罩置入反应阳性,则下一例患者羟考酮用量增加1个阶梯剂量,否则降低1个阶梯剂量,相邻剂量比值1.1,重复此过程,直到出现第7个转折点。喉罩置入反应阳性标准:喉罩置入后2 min内心率最大值或平均动脉压最大值的升高幅度超过置入即刻水平的20%。采用probit法确定羟考酮抑制喉罩置入反应的半数有效剂量(ED_(50))。结果M组最终纳入28例,F组25例。M组ED_(50)(95%可信区间)为0.105(0.091~0.115)mg/kg,F组ED_(50)(95%可信区间)为0.087(0.082~0.094)mg/kg。M组ED50高于F组(P<0.01)。结论羟考酮抑制患者喉罩置入诱发伤害性刺激的效应与性别因素有关,对女性的效力增强。Objective To evaluate the effect of gender factors on the potency of oxycodone inhibiting responses to laryngeal mask airway(LMA)insertion in patients.Methods American Society of Anesthesiologists Physical Status classificationⅠorⅡpatients,aged 18-59 yr,with a body mass index of 18-28 kg/m^(2),scheduled for elective surgery with general anesthesia using LMA,were divided into 2 groups according to gender:male group(group M)and female group(group F).The dose of oxycodone was determined by using modified Dixon′s up-and-down method.Oxycodone 0.1 mg/kg was intravenously infused in the first patient of each group,and propofol 3μg/ml was simultaneously given by target-controlled infusion.When bispectral index value≤60 after the equilibration between effect-site concentration and plasma concentration was achieved,cisatracurium 0.2 mg/kg was intravenously injected,and 3 min later the LMA was inserted.When the response to LMA insertion was positive,the dose of oxycodone was increased in the next patient,otherwise the dose was decreased,and the ratio between the two successive doses was 1.1.The process was repeated until the 7th turning point occurred.The positive response to LMA insertion was defined as an increase in the maximum heart rate or in the maximum mean arterial pressure>20% of the baseline value with 2 min after insertion.The median effective dose(ED50)and 95% confidence interval of oxycodone inhibiting responses to LMA insertion were calculated by the probit analysis.Results Twenty-eight cases were finally included in M group and 25 cases in F group.The ED50(95% confidence interval)of oxycodone was 0.105(0.091-0.115)mg/kg in group M and 0.087(0.082-0.094)mg/kg in group F.The ED50 of oxycodone was significantly higher in group M than in group F(P<0.001).Conclusions The effect of oxycodone inhibiting responses to nociceptive stimulation induced by LMA insertion is related to gender factors,with increased potency in females.

关 键 词：性别因素 羟可酮 喉面罩 剂量效应关系 药物 

分 类 号：R614[医药卫生—麻醉学]