复合舒芬太尼时环泊酚抑制喉罩置入反应的量效关系  

Dose‑effect relationship of ciprofol combined with sufentanil in inhibiting the response to laryngeal mask airway insertion

作　　者：崔家田 陈觅 杨扬 邱丽 胡秋艳 曾祥刚 邹小华 Cui Jiatian;Chen Mi;Yang Yang;Qiu Li;Hu Qiuyan;Zeng Xianggang;Zou Xiaohua(College of Anesthesia,Guizhou Medical University,Guiyang 550004,China;Department of Anesthesiology,Affiliated Hospital of Gui-zhou Medical University,Guiyang 550004,China;Department of Anesthesiology,Luodian Branch,Affiliated Hospital of Guizhou Medi-cal University,Luodian County People's Hospital,Luodian 550100,China)

机构地区：[1]贵州医科大学麻醉学院,贵阳550004 [2]贵州医科大学附属医院麻醉科,贵阳550004 [3]贵州医科大学附属医院罗甸分院/罗甸县人民医院麻醉科,黔南州550100

出　　处：《国际麻醉学与复苏杂志》2024年第5期499-503,共5页International Journal of Anesthesiology and Resuscitation

基　　金：贵州省教育厅项目(黔教合KY字[2022]236号)。

摘　　要：目的探讨复合舒芬太尼时环泊酚抑制喉罩置入反应的量效关系。方法择期行喉罩置入全身麻醉手术患者23例,性别不限,年龄18~60岁,体重指数(BMI)18~30 kg/m2,美国麻醉医师协会(ASA)分级Ⅰ、Ⅱ级。麻醉诱导予静脉注射舒芬太尼0.3μg/kg,5 min后静脉注射环泊酚,患者意识消失后静脉注射罗库溴铵0.6 mg/kg,3 min后置入喉罩。环泊酚剂量由序贯法确定,初始剂量为0.30 mg/kg,剂量梯度为0.05 mg/kg,根据是否发生喉罩置入反应确定下一例患者的环泊酚剂量。若喉罩置入时出现体动、口角动、呛咳、皱眉、流泪、喉痉挛等反应,或喉罩置入后3 min内的心率或血压升高幅度超过麻醉前基础值20%为阳性反应。若喉罩置入反应阳性或2 min内改良警觉/镇静评分量表(mOAA/S)评分仍>1分,则下一例患者的环泊酚上升一个剂量梯度,否则下降一个剂量梯度。记录患者进入手术室后(T_(1))、麻醉诱导后(T_(2))、喉罩置入后(T_(3))时的心率、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、脉搏血氧饱和度(SpO_(2)),记录T_(2)时0.20~0.30 mg/kg环泊酚注射后2 min内患者意识消失时间并计算患者意识消失成功率,记录麻醉诱导后不良反应(心动过缓、低血压、注射痛)发生情况等。采用Probit法计算环泊酚抑制喉罩置入反应的半数有效量(ED50)、95%有效量(ED95)和各自95%置信区间(CI)。结果与T_(1)比较,T_(2)、T_(3)时心率、SBP、DBP、MAP降低(均P<0.05),SpO_(2)升高(均P<0.05)。T_(2)时,0.20~0.30 mg/kg环泊酚注射后2 min内意识消失成功患者的意识消失时间为(71.0±17.8)s。环泊酚0.15、0.20、0.25、0.30 mg/kg注射后2 min内意识消失成功率分别为0、40.0%、85.7%、100%。麻醉诱导后5例(21.7%)患者发生心动过缓,7例(30.4%)患者发生低血压,1例(4.35%)患者发生注射痛。复合舒芬太尼时环泊酚抑制喉罩置入反应的ED50及其95%CI为0.212(0.182~0.242)mg/kg、ED95及其95%CI为0.265(0.23Objective To investigate the dose‑effect relationship of ciprofol in inhibiting the response to laryngeal mask airway insertion when used in combination with sufentanil.Methods A total of 23 patients,men or women,aged 18−60 years,with body mass index(BMI)of 18−30 kg/m2,American Society of Anesthesiologists(ASA)ⅠorⅡ,who underwent elective laryngeal mask airway insertion under general anesthesia were selected.Anesthesia induction was conducted through intravenous injection of sufentanil at 0.3μg/kg,followed by intravenously injection ciprofol 5 min later.After the patients became unconscious,they were intravenously injected with 0.6 mg/kg of rocuronium,before laryngeal mask airway insertion 3 min later.The dose of ciprofol was determined by the up‑and‑down method,with an initial dose of 0.30 mg/kg and a dose gradient of 0.05 mg/kg.The next patient's ciprofol dose was determined according to the response to laryngeal mask airway insertion.The response was positive,when body movement,mouth movement,choking cough,frowning,tears,laryngeal spasm and other reactions occurred during laryngeal mask airway insertion,or the heart rate or blood pressure increased by 20%of pre‑anesthesia baseline within 3 min after laryngeal mask airway insertion.If the response to laryngeal mask airway insertion was positive,or the modified Observer's Assessment of Alertness/Sedation(mOAA/S)score was more than 1 point within 2 min,the dose of ciprofol would increase by one gradient in the next patient,or decrease by one gradient.Their heart rate,systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),and pulse oxygen saturation(SpO_(2))were recorded after the patients entered the operation room(T_(1)),after anesthesia induction(T_(2)),and after laryngeal mask airway insertion(T_(3)).The time to loss of consciousness within 2 min after injection of 0.20−0.30 mg/kg ciprofol at T_(2)was recorded and the success rate of loss of consciousness was calculated.The incidences of adverse reactions after

关 键 词：环泊酚 舒芬太尼 喉罩 剂量效应关系 

分 类 号：R614[医药卫生—麻醉学]