瑞马唑仑用于先天性心脏病患儿麻醉诱导的半数有效剂量和95%有效剂量探讨  

Median effective dose and 95%effective dose of remimazolam for anesthesia induction in children with congenital heart disease

作　　者：晋铭 邱林[2] 林洪启[2] 徐红党[2] 张浩然[2] 李雪[2] Jin Ming;Qiu Lin;Lin Hongqi;Xu Hongdang;Zhang Haoran;Li Xue(Department of Anesthesia and Perioperative Medicine,Henan Provincial People's Hospital,Henan University People's Hospital,Zhengzhou 450000,China;Department of Anesthesiology,Central China Fuwai Hospital,Central China Fuwai Hospital of Zhengzhou University,Henan Provincial People's Hospital,Zhengzhou 450008,China)

机构地区：[1]河南省人民医院河南大学人民医院麻醉与围术期医学科,河南郑州450000 [2]华中阜外医院郑州大学华中阜外医院河南省人民医院麻醉科,河南郑州450008

出　　处：《实用药物与临床》2025年第2期107-110,共4页Practical Pharmacy and Clinical Remedies

摘　　要：目的研究瑞马唑仑用于先天性心脏病患儿麻醉诱导的半数有效剂量(ED50)和95%有效剂量(ED95)。方法选取华中阜外医院2023年12月1日至2024年5月10日拟开胸行心脏手术的左向右分流型心脏病患儿26例,年龄3~6岁,采用Dixon上下序贯法进行试验,瑞马唑仑的初始剂量为0.4 mg/kg,若患儿意识消失则下一例患儿减少0.025 mg/kg,否则下一例增加0.025 mg/kg。意识消失的标准:给药后1 min后改良警觉镇静评分(MOAA/S)≤1分且睫毛反射无反应。意识消失后给予顺式阿曲库铵0.2 mg/kg,舒芬太尼1.0μg/kg,随后进行气管插管。记录不同时间点的心率、血压、心排指数、每搏输出指数、外周血管阻力指数、心肌收缩指数和麻醉诱导期间不良反应的发生情况,Probit概率回归分析计算ED50和ED95。结果瑞马唑仑用于先天性心脏病患儿麻醉诱导的ED50(95%CI)为0.455(0.414~0.583)mg/kg,ED95(95%CI)为0.536(0.489~1.690)mg/kg。与诱导前(T_(0))相比,插管前(T_(1))、插管时(T_(2))、插管后2 min(T_(4))和插管后3 min(T5)时的平均动脉压降低(P<0.05),但处于正常范围。麻醉诱导期间1例患儿发生呃逆,未出现其他不良反应。结论瑞马唑仑用于先天性心脏病患儿麻醉诱导时的ED50为0.455 mg/kg,ED95为0.536 mg/kg。Objective To investigate the median effective dose(ED50)and 95%effective dose(ED95)of remimazolam for anesthesia induction in children with congenital heart disease.Methods A total of 26 children with left-to-right shunt heart disease,aged 3 to 6 years,who planned to undergo open-chest heart surgery in Central China Fuwai Hospital from December 1,2023 to May 10,2024,were selected for the study.The Dixon up-and-down method was employed with the initial dose of remimazolam set at 0.4 mg/kg.If the patient lost consciousness,the next patient's dose was reduced by 0.025 mg/kg;otherwise,the dose was increased by 0.025 mg/kg.The criterion for loss of consciousness was defined as a Modified Observer's Assessment of Alertness/Sedation(MOAA/S)score of≤1 and no response to eyelash reflex after 1 minute of administration.Following loss of consciousness,cis-atracurium(0.2 mg/kg)and sufentanil(1.0μg/kg)were administered,followed by tracheal intubation.Heart rate,blood pressure,cardiac index,stroke volume index,peripheral vascular resistance index,myocardial contractility index,and adverse reactions during anesthesia induction were recorded at different time points.The ED50 and ED95 were calculated using Probit regression analysis.Results The ED50(95%CI)of remimazolam for anesthesia induction in children with congenital heart disease was determined to be 0.455(0.414~0.583)mg/kg,and the ED95(95%CI)was 0.536(0.489~1.690)mg/kg.Compared to pre-induction(T_(0)),the mean arterial pressure decreased at pre-intubation(T_(1)),during intubation(T_(2)),2 min post-intubation(T_(4)),and 3 min post-intubation(T5)(P<0.05),but remained within the normal range.One child experienced hiccups during anesthesia induction,but no other adverse reactions were observed.Conclusion Remimazolam can be used for anesthesia induction in children with congenital heart disease,with an ED50 of 0.455 mg/kg and an ED95 of 0.536 mg/kg.

关 键 词：瑞马唑仑 先天性心脏病 儿童 麻醉诱导 半数有效剂量 

分 类 号：R61[医药卫生—外科学]