国际麻醉学与复苏杂志   2012, Issue (5): 2-2
    
舒芬太尼对老年患者诱导期丙泊酚抑制气管插管反应Cp50的影响
贺文丽, 秦再生, 王辉, 叶靖, 徐建设1()
1.南方医科大学南方医院
Cp50 of propofol blunting cardiovascular responses to tracheal intubation on anesthesia induction with sufentanil in elderly patients
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摘要:

目的 探讨不同靶浓度的舒芬太尼复合丙泊酚靶控输注抑制气管插管反应的丙泊酚半数有效血浆浓度(the median effective plasma concentration,Cp50) 。 方法 研究对象为94例择期全麻拟行气管插管手术患者,ASAⅠ~Ⅲ级,年龄在60~79岁。根据年龄段和舒芬太尼靶浓度的不同随机分为四组,A组为60~69岁、0.2ng/ml;B组为60~69岁、0.3ng/ml;C组为70~79岁、0.2ng/ml;D组为70~79岁、0.3ng/ml。试验以效应室浓度靶控输注(targeted-controlled infusion ,TCI)舒芬太尼,待舒芬太尼血浆浓度与效应室浓度平衡后,以血浆靶浓度TCI丙泊酚,意识消失后给予0.2mg/kg的顺阿曲库铵,待丙泊酚的血浆浓度和效应室浓度平衡且静注顺阿曲库铵达3分钟后行气管插管。丙泊酚的血浆靶浓度按序贯法确定。 结果 A组患者有效抑制气管插管反应的丙泊酚的为3.60μg /ml,95%CI为3.34~3.86μg /ml;B组患者Cp50为2.03μg/ml,95%CI为1.86~2.20μg/ml;C组患者Cp50为2.70μg/ml,95%CI为2.56~2.84μg/ml;D组患者Cp50为1.97μg/ml,95%CI为1.86~2.08μg/ml。 结论 随着舒芬太尼的效应室靶浓度的增加以及年龄的增加,丙泊酚的Cp50明显降低。

关键词: 丙泊酚;舒芬太尼;靶控输注;半数有效血浆浓度;气管插管;老年人
Abstract:

Objective To investigate the median effective plasma concentration (Cp50) of propofol blunting cardiovascular responses to tracheal intubation with sufentanil at different targeted concentrations on anesthesia induction in elderly patients. Methods Ninty-four patients (60~79years) with an American Society of Anesthesiologists(ASA)physical status of Ⅰ~Ⅲ,undergoing scheduled surgery under general intubation were randomly allocated into one of four groups,Group A, B, C and D.The patients in Group A and Group B (60~69years) and the ones in Group C and Group D(70~79years) received sufentanil with a target effect concentration of 0.2ng/ml,0.3ng/ml,respectively. Induction of anesthesia was initiated by TCI sufentanil at target effect-site concentration and the target effect-site concentration of sufentanil was maintained stable before administration of propofol determined by up and down sequential test. At the moment of loss of consciousness, cis-atracurium 0.2mg/kg was administered. Intubation was performed for 3 min later. Results The Cp50 of propofol were 3.60, 2.03, 2.70 , 1.97μg /ml with 95% confidence interval of 3.34~3.86, 1.86~2.20, 2.56~2.84, 1.86~2.08μg/ml in Group A, B, C and D,respectively. Conclusion With the concentrations of sufentanil or age increased,the Cp50 of propofol decresed in elderly patients.

Key words: propofol;sufentanil;targeted-controlled infusion;the median effective plasma concentration ;tracheal intubation;the elderly