复合环泊酚麻醉诱导时舒芬太尼抑制老年患者气管插管心血管反应的半数有效效应室浓度  

Median effect-site concentration of sufentanil combined with ciprofol blunting cardiovascular responses to tracheal intubation in elderly patients

作　　者：梅凤美[1] 赵金兵[2] 金晶星[1] 陆军[1] 曾琼[1] MEI Fengmei;ZHAO Jinbing;JIN Jingxing;LU Jun;ZENG Qiong(Department of Anesthesiology,Brain Hospital Affiliated to Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学附属脑科医院麻醉科,210029 [2]南京医科大学附属脑科医院脑血管救治中心,210029

出　　处：《临床麻醉学杂志》2024年第11期1165-1169,共5页Journal of Clinical Anesthesiology

基　　金：江苏省卫生健康委医学科研项目(M2023223);南京市卫生科技发展专项资金项目(YKK22136)。

摘　　要：目的探讨并比较复合丙泊酚或环泊酚诱导时舒芬太尼抑制老年患者气管插管心血管反应的半数有效效应室浓度(Ce_(50))。方法选择择期行气管插管全麻颅内外血运重建术的老年患者66例,男32例,女34例,年龄≥65岁,BMI 20~30 kg/m^(2)。将患者随机分为两组:丙泊酚组(P组)和环泊酚组(C组),每组33例。两组首例患者靶控输注舒芬太尼0.30 ng/ml,达到效应室浓度后根据分组分别缓慢静脉注射丙泊酚1.5 mg/kg或环泊酚0.30 mg/kg,待患者意识消失且BIS≤60,给予罗库溴铵0.60 mg/kg,肌松完全TOF为0后行气管插管。气管插管心血管阳性反应为气管插管后2 min内HR或SBP升高幅度超过基础值的20%。舒芬太尼的靶浓度由序贯法确定,相邻浓度梯度比为1∶1.2。根据气管插管反应,上调或下降一个浓度梯度,直至第7个阳性反应-阴性反应交叉点时结束试验。记录麻醉诱导前(T_(0))、气管插管前(T_(1))、气管插管后1 min(T_(2))、气管插管后3 min(T_(3))和气管插管后5 min(T_(4))的HR、SBP、DBP和BIS。采用Dixon-Mood半数有效量序贯法计算公式计算Ce_(50)及其95%可信区间(CI)。结果与P组比较,C组T_(1)时SBP明显升高;T_(2)—T_(4)时BIS明显降低(P<0.05)。P组和C组舒芬太尼抑制气管插管心血管反应的Ce_(50)分别为0.253 ng/ml(95%CI 0.215~0.297 ng/ml)和0.241 ng/ml(95%CI 0.209~0.279 ng/ml),两组Ce_(50)差异无统计学意义。结论麻醉诱导复合丙泊酚1.5 mg/kg时舒芬太尼抑制老年患者气管插管心血管反应的Ce_(50)为0.253 ng/ml(95%CI 0.215~0.297 ng/ml),复合环泊酚0.30 mg/kg时舒芬太尼抑制老年患者气管插管心血管反应的Ce_(50)为0.241 ng/ml(95%CI 0.209~0.279 ng/ml)。Objective To investigate and compare the median effect-site concentration(Ce_(50))of sufentanil combined with propofol or ciprofol blunting cardiovascular responses to tracheal intubation in elderly patients.Methods Sixty-six elderly patients were selected for extracranial-intracranial cerebral revascularization for general anesthesia with tracheal intubation,32 males and 34 females,aged≥65 years,BMI 20-30 kg/m^(2).Patients were randomly divided into two groups:1.5 mg/kg propofol group(group P)and 0.3 mg/kg ciprofol group(group C),33 patients in each group.Sufentanil was target controlled infused with the initial dose of 0.30μg/kg,then propofol 1.5 mg/kg or ciprofol 0.30 mg/kg injected slowly after reaching the effect-site concentration.After the lose of consciousness and BIS score less than or equal to sixty,rocuronium 0.60 mg/kg was administrated,and underwent endotracheal intubation after the TOF value monitored by muscle relaxation drops to zero.Dixon s up and down sequential method was used to determined the target concentration of sufentanil.A positive response was defined as a 20%increase in HR or SBP exceeding the baseline within 2 minutes after tracheal intubation,otherwise,it was considered a negative response.According to the Dixon s sequential method,the ratio of adjacent dosed was 1.2 and if the patient had a positive response,the dose of next patient was moved up one gradient,otherwise,the dose would be reduced.The trail was terminated when the seventh crossover point was observed.When a positive response turned to a negative response,it was called a crossover point.HR,SBP,DBP and BIS were recorded before induction of anesthesia(T_(0)),before tracheal intubation(T_(1)),1 minutes after tracheal intubation(T_(2)),3 minutes after tracheal intubation(T_(3))and 5 minutes after tracheal intubation(T_(4)).Dixon-Mood s half effective quantity sequential calculation formula was used to calculate the Ce_(50)and 95%confidence interval(CI).Results Compared with group P,SBP was significantly increased at T_(1

关 键 词：半数有效浓度 舒芬太尼 环泊酚 气管插管 老年 

分 类 号：R614[医药卫生—麻醉学]