国际麻醉学与复苏杂志   2017, Issue (1): 8-8
    
羟考酮抑制中老年患者全身麻醉诱导期依托咪酯所致肌阵挛的半数有效量
汪伟, 郁万友, 钱燕宁1()
1.南京医科大学附属江宁医院
50% effect dose of oxycodone for inhibition of myoclonus induced by etomidate during the induction of general anesthesia in middle-aged or elderly patients
 全文:
摘要:

目的 观察羟考酮抑制中老年患者全身麻醉诱导期依托咪酯所致肌阵挛的药效学。 方法 择期全身麻醉下手术患者62例, ASA分级Ⅰ、Ⅱ级。分为两组:中年组(45~54岁)30例,老年组(65~74岁)32例。麻醉诱导:患者面罩吸氧(8 L/min)5 min后,采用改良序贯法30 s内静脉注射羟考酮。2 min后30 s内静脉注射依托咪酯0.3 mg/kg,持续观察2 min,评估肌阵挛发生情况及其程度。然后静脉注射顺式阿曲库铵2 mg/kg和芬太尼3 μg/kg,5 min内完成气管插管行机械通气。麻醉分别以靶控输注(target controlled infusion, TCI)丙泊酚(3.0 mg/L)、瑞芬太尼(2.5~3.0 μg/L)维持。采用Probit 回归方法分析各组羟考酮的ED50及其95%CI,并记录手术时间、术后拔管时间及恶心、呕吐等副作用。 结果 羟考酮抑制中老年患者全身麻醉诱导期依托咪酯所致肌阵挛的ED50分别为0.077 mg/kg和0.062 mg/kg,95%CI分别为0.045~0.122 mg/kg和0.043~0.101 mg/kg;中年组羟考酮剂量明显高于老年组患者(P<0.05)。两组患者副作用发生率比较,差异无统计学意义(P>0.05)。 结论 羟考酮抑制中老年患者全身麻醉诱导期依托咪酯所致肌阵挛的ED50分别为0.077 mg/kg与0.062 mg/kg;95%CI分别为0.045~0.122 mg/kg与0.043~0.101 mg/kg。

关键词: 羟考酮; 依托咪酯; 肌阵挛; 老年
Abstract:

Objective To observe the effect of oxycodone for inhibition of myoclonus induced by etomidate during the induction of general anesthesia in middle-aged or elderly patients. Methods Sixty-two cases of patients undergoing elective general anesthesia, ASA Ⅰor Ⅱ grade, were assigned into middle aged group (45 to 54 years old) 30 cases, and aged group (65 to 74 years old) 32 cases. Induction of anesthesia: with oxygen mask(8 L/min) for five minutes, all patients were injected oxycodone intravenously in thirty seconds with modified sequential method. Two minutes later, all were injected etomidate 0.3 mg/kg intravenously in thirty seconds. Then, we assessed the occurrence and degree of myoclonus for two minutes continuously. After that, we administrated cisatracurium 2 mg/kg and fentanyl 3 μg/kg. We completed the mechanical ventilation with tracheal intubation in five minutes. Anesthesia was maintained with propofol(3.0 mg/L)and remifentanil(2.5~3.0 μg/L) in target controlled infusion(TCI) mode until the end of surgery. ED50 and 95%CI of oxycodone during the induction of general anesthesia were calculated. The total time of operation, extubation time and adverse effects such as nausea and vomiting were also recorded. Results ED50 of the middle-aged group and elderly group was 0.077 mg/kg and 0.062 mg/kg, and 95%CI of the two groups was 0.045-0.122 mg/kg and 0.043~0.101 mg/kg respectively. The dose of oxycodone used in middle-aged group was significantly higher than that in elderly patients group(P<0.05). There was no significant difference of adverse reaction between the two groups(P>0.05). Conclusions The ED50 and 95%CI of oxycodone for inhibition of myoclonus induced by etomidate during the induction of general anesthesia in middle-aged or elderly patients are 0.077 mg/kg and 0.062 mg/kg, 0.045-0.122 mg/kg and 0.043-0.101 mg/kg respectively.

Key words: Oxycodone; Etomidate; Myoclonus; Elderly