环泊酚用于老年患者椎管内麻醉辅助镇静的药效学  

Pharmacodynamics of ciprofol for adjunctive sedation in elderly patients undergoing neuraxial anesthesia

作　　者：李波[1] 岳维[2] 田彦东 熊明兴 高颖[1] Li Bo;Yue Wei;Tian Yandong;Xiong Mingxing;Gao Ying(College of Anesthesiology, Shanxi Medical University, Taiyuan 030001, China;Department of Anesthesiology, the Second Hospital of Shanxi Medical University, Taiyuan 030001, China)

机构地区：[1]山西医科大学麻醉学院,太原030001 [2]山西医科大学第二医院麻醉科,太原030001

出　　处：《中华麻醉学杂志》2024年第7期839-842,共4页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金(34100940)。

摘　　要：目的确定环泊酚用于老年患者椎管内麻醉辅助镇静的药效学。方法本研究为前瞻性研究。选择山西医科大学第二医院2023年6月至9月椎管内麻醉下行择期膝关节置换术患者。年龄≥65岁,BMI 18~30 kg/m^(2),ASA分级Ⅰ-Ⅲ级。椎管内麻醉完成后,静脉泵注环泊酚,负荷剂量0.05 mg/kg(给药时间约4 min)。采用序贯法确定维持剂量,初始维持剂量为0.2 mg·kg^(-1)·h^(-1),剂量梯度为0.02 mg·kg^(-1)·h^(-1)。镇静满意则下一例患者环泊酚给药剂量下降一级;镇静不满意,下一例患者环泊酚给药剂量上升一级,发生8次转折后结束试验。记录给药及苏醒期间不良反应发生情况。采用probit概率回归法计算环泊酚的半数有效剂量(ED50)、95%有效剂量(ED95)及其95%可信区间(CI)。结果共纳入35例患者。环泊酚用于老年患者椎管内麻醉辅助镇静的ED50为0.246 mg·kg^(-1)·h^(-1)(95%CI 0.217~0.300 mg·kg^(-1)·h^(-1)),ED95为0.325 mg·kg^(-1)·h^(-1)(95%CI 0.284~0.771 mg·kg^(-1)·h^(-1))。环泊酚给药期间,发生心动过缓4例(11%)、低血压2例(6%)、低氧血症2例(6%),经处理后均改善;均未见注射痛、异常肢体运动、苏醒期躁动、头晕、头痛、恶心呕吐、术后谵妄发生。结论环泊酚用于椎管内麻醉老年患者辅助镇静的ED50为0.246 mg·kg^(-1)·h^(-1),ED95为0.325 mg·kg^(-1)·h^(-1)。Objective To determine the pharmacodynamics of ciprofol for adjunctive sedation in elderly patients undergoing neuraxial anesthesia.Methods This was a prospective study.American Society of Anesthesiologists Physical Status classificationⅠ-Ⅲpatients of either sex,aged≥65 yr,with a body mass index of 18-30 kg/m^(2),scheduled for elective knee replacement under neuraxial anesthesia from June to September 2023 in the Second Hospital of Shanxi Medical University,were selected.After completion of neuraxial anesthesia,ciprofol was pumped intravenously at a loading dose of 0.05 mg/kg(administered for approximately 4 min).The maintenance dose was determined by the sequential method.The initial maintenance dose was 0.2 mg·kg^(-1)·h^(-1),and the dose gradient was 0.02 mg·kg^(-1)·h^(-1).If the patient was satisfactorily sedated,the dose of ciprofol was decreased by 0.02 mg·kg^(-1)·h^(-1)in the next patient;if the sedation was unsatisfactory,the dose of ciprofol was increased by 0.02 mg·kg^(-1)·h^(-1)in the next patient,and the trial was terminated after 8 transitions.The occurrence of adverse reactions was recorded during administration and emergence.The median effective dose(ED 50),95%effective dose(ED 95)and the corresponding 95%confidence interval(CI)of ciprofol were calculated using the probit regression analysis.Results Thirty-five patients were finally included in this study.The ED 50 of ciprofol for adjunctive sedation was 0.246 mg·kg^(-1)·h^(-1)(95%CI 0.217-0.300 mg·kg^(-1)·h^(-1)),and the ED 95 was 0.325 mg·kg^(-1)·h^(-1)(95%CI 0.284-0.771 mg·kg^(-1)·h^(-1))in elderly patients undergoing knee arthroplasty under neuraxial anesthesia.During the administration of ciprofol,bradycardia occurred in 4 cases(11%),hypotension in 2 cases(6%),and hypoxemia in 2 cases(6%),which improved after treatment.No injection pain,abnormal limb movements,agitation during emergence,dizziness,headache,nausea and vomiting and postoperative delirium developed in patients.Conclusions The ED 50 of ciprofol for adjunctive s

关 键 词：环泊酚 老年人 麻醉 脊椎 清醒镇静 剂量效应关系 药物 

分 类 号：R614[医药卫生—麻醉学]