瑞芬太尼复合环泊酚抑制气管插管反应的有效浓度研究  

Study on Effective Concentration of Remifentanil Combined with Ciprofol toInhibit Tracheal Intubation Response

作　　者：郭佳宁 徐方胜 李春雨[2] GUO Jianing;XU Fangsheng;LI Chunyu(Department of Anesthesiology,Peace Hospital Affiliated to Changzhi Medical College)

机构地区：[1]长治医学院第一临床学院,山西长治046000 [2]长治医学院附属和平医院麻醉科

出　　处：《长治医学院学报》2024年第3期213-216,共4页Journal of Changzhi Medical College

基　　金：长治医学院校级研究生教育改革(指令性)研究课题(CY2020JG05)。

摘　　要：目的:探寻瑞芬太尼复合环泊酚抑制气管插管反应的90%有效浓度(EC90)。方法:采用偏币设计方法,对60例气管插管择期手术患者行前瞻性序贯分配剂量发现研究。设置瑞芬太尼初始效应室浓度(Ce)2 ng·mL^(-1),间隔浓度梯度为0.5 ng·mL^(-1)。后一患者的瑞芬太尼Ce由前一患者对气管插管反应的抑制效果确定。EC90及其90%CI使用保序回归(Isotonic regression)和Bootstrapping方法确定。结果:在全身麻醉诱导气管插管中,瑞芬太尼复合环泊酚抑制气管插管反应的EC90为4.00 ng·mL^(-1),90%CI为3.82~4.73;麻醉诱导过程中有2例患者出现头晕症状,3例患者出现心动过缓和低血压症状,气管插管过程中未出现呛咳、体动、流泪等不良反应。结论:确定了瑞芬太尼复合环泊酚抑制气管插管反应的90%有效浓度,此药效学参数可为临床选择合适的药物浓度提供参考。Objective:To investigate 90%effective concentration(EC 90)of remifentanil combined with ciprofol for inhibiting response to tracheal intubation.Methods:Based on a biased coin up-and-down design,a prospective sequential dose discovery study was conducted on 60 patients undergoing elective surgery for endotracheal intubation.The initial effect site concentration of remifentanil was set to 2 ng·mL^(-1).If the patient's maximum increase in SBP or HR within 2 minutes after the endotracheal intubation is inflated≤20%of the baseline value,It indicates that the effect of targeted controlled infusion of remifentanil Ce under Ciprofol anesthesia on intubation stimulation is satisfactory(successful),The next patient's remifentanil Ce was then randomized to the next lower dose,with a decrease of 0.5 ng·mL^(-1)(probability 1/9)or the same Ce(probability 8/9).If>20%of the baseline value,indicates that the anesthesia is inadequate(failed),and the effect site concentration of remifentanil rises by 0.5 ng·mL^(-1) in the next patient.EC90 and its 90%CI were determined using isotonic regression and bootstrapping methods.Results:In general anesthesia-induced endotracheal intubation,the EC90 for inhibition of endotracheal intubation response by remifentanil combined with ciprofol was 4.00 ng·mL^(-1),90%CI was 3.82~4.73.During anesthesia induction,2 patients had dizziness symptoms,and 3 patients experienced bradycardia and hypotension.There were no untoward reactions,such as choking,body movement,or shedding tears throughout the intubation process.Conclusion:The effective concentration of remifentanil combined with ciprofol to inhibit tracheal incubation reaction was determined.This can serve as a reference for the clinical selection of the optimum drug concentration.

关 键 词：瑞芬太尼 环泊酚 气管插管反应 偏币设计 

分 类 号：R614[医药卫生—麻醉学]