国际麻醉学与复苏杂志   2018, Issue (11): 0-0
    
瑞芬太尼靶控输注抑制肥胖患者气管拔管反应的 最适血浆靶浓度
乔南南, 徐桂萍, 潘阳阳, 阿里木江, 唐冬梅1()
1.新疆维吾尔自治区人民医院麻醉科
The optimal plasma concentration of remifentanil for target-controlled infusion to suppress extubation response in obese patients
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摘要:

目的 探讨全身麻醉苏醒期瑞芬太尼持续靶控输注(target controlled infusion, TCI)抑制肥胖患者气管拔管反应的最适血浆浓度。 方法 择期全身麻醉下行腹腔镜胆囊切除术(laparoscopic cholecystectomy, LC)的肥胖患者70例,ASA分级Ⅰ、Ⅱ级,BMI 30~35 kg/m2,采用随机数字表法分为对照组(20例)、试验组(50例)。试验组拔管时采用改良Dixon序贯法进行瑞芬太尼剂量研究, 并通过Probit 概率回归分析计算得出瑞芬太尼抑制拔管反应的半数有效浓度(median effective concentration, EC50)及其95%CI。记录试验组各浓度患者拔管时间并与对照组进行比较。 结果 TCI瑞芬太尼抑制肥胖患者全身麻醉拔管反应的EC50为1.58 μg/L(95%CI为1.40~1.81 μg/L)。瑞芬太尼TCI血浆靶浓度1.40~1.81 μg/L时拔管时间为(8.5±0.4) min,与对照组拔管时间(8.3±0.6) min比较差异无统计学意义(P>0.05)。 结论 瑞芬太尼TCI既能抑制肥胖患者全身麻醉拔管反应,又不影响患者拔管时间的最适血浆靶浓度为1.58 μg/L。

关键词: 瑞芬太尼; 靶控输注; 拔管反应; 半数有效浓度
Abstract:

Objective To investigate the optimal plasma concentration of remifentanil for target-controlled infusion (TCI) to inhibit extubation response in obese patients under general anesthesia. Methods A total of 70 obese patients, at ASA gradeⅠ, Ⅱ and with BMI of 30-35 kg/m2, were randomly divided into control group (n=20) and experimental group (n=50) undergoing elective anesthesia with laparoscopic cholecystectomy. The modified Dixon sequential method was used in the experimental group, and the median effective concentration (EC50) of remifentanil and its 95%CI were calculated with probit probability regression analysis. The extubation time in patients subjected to remifentanil at different concentrations for TCI was recorded and compared with that in the control group. Results The EC50 of plasma remifentanil for TCI to inhibit extubation reaction was 1.58 μg/L (95%CI was 1.40-1.81 μg/L) in obese patients under general anesthesia. The extubation time in patients received 1.40-1.81 μg/L remifentanil for TCI (8.5±0.4) min did not differ from that in control group (8.3±0.6) min (P>0.05). Conclusions Remifentanil at concentration of 1.58 μg/L for TCI inhibited extubation reaction but without affecting the extubation time in obese patients under general anesthesia.

Key words: Remifentanil; Target controlled infusion; Extubation response; Median effective concentration