不同效应室靶浓度舒芬太尼对丙泊酚意识消失EC50的影响

Influence of different target effect-site concentration of sufentanil on popofol EC50 at loss of consciousness

目的在脑电双频指数(BIS)监测指导下,根据舒芬太尼不同效应室靶浓度,探讨舒芬太尼复合丙泊酚应用时的协同作用特点及舒芬太尼和芬太尼的效价关系。方法择期全身麻醉手术女性患者60例,ASAⅠ或Ⅱ级,30～50岁,50～70kg,随机分为三组(每组20例)。分别静脉输注舒芬太尼效应室靶浓度0.3ng/ml(S1组),舒芬太尼效应室靶浓度0.5ng/ml(S2组),芬太尼效应室靶浓度3ng/ml(F组),当各组患者效应室药物浓度与血浆药物浓度平衡时,丙泊酚血浆靶浓度按序贯法输注,观察记录各组患者意识消失时的丙泊酚血浆药物浓度及BIS值。利用回归分析方法计算出不同靶浓度舒芬太尼和芬太尼使患者意识消失的丙泊酚EC50。调节丙泊酚靶浓度持续输注,待所有患者BIS值降至60后给予维库溴铵0.12mg/kg,1min后行气管插管。分别记录各组患者入室时(基础值)、芬太尼类药物效应室药物浓度与血浆药物浓度平衡时、丙泊酚达到预定血浆药物浓度时、气管插管后即刻各时点心率(HR)、血压(BP)、平均动脉压(MAP)、血氧饱和度(SpO2)、BIS。结果舒芬太尼靶浓度0.3ng/ml诱导时,丙泊酚意识消失EC50是4.13μg/ml,95%置信区间是3.95～4.32μg/ml;舒芬太尼靶浓度0.5ng/ml诱导时,丙泊酚意识消失EC50是3.58μg/ml,95%置信区间是3.39～3.76μg/ml。结论随着舒芬太尼靶浓度增加丙泊酚意识消失EC50下降,舒芬太尼和丙泊酚有更强的协同作用,舒芬太尼和芬太尼的效价比随刺激强度而变化,范围在(6～10)∶1。

Objective Under the monitoring of bispectral index,using various target effect-site concentration of sufentanil,to investigate the synergistic interaction characteristics between sufentanil and propofol and explore the dose ratio between sufentanil and fentanyl as an equipotent,to provide reference for clinical work.Methods Sixty female patients with ASA physical status Ⅰ-Ⅱ scheduled for elective surgery,were randomly allocated into three groups of 20 patients each:group S1,group S2 and group F.Group S1 received intravenous target effect-site concentration of sufentanil 0.3 ng/ml and group S2 received sufentanil 0.5 ng/ml,group F received fentanyl 3 ng/ml.When the plasma concentration of sufentanil and fentanyl came into balance with effect-site,then TCI propofol in an up and down method.At the time loss of consciousness,the plasma concentration of propofol and the BIS were recorded.Then use the regression method to calculate the propofol EC50 at the time loss of consciousness.Propofol was infused continuously,when the BIS decreased lower than 60,vecuronium at a dose of 0.12 mg/kg was injected,after that tracheal intubation was performed.The HR,BP,MAP,SpO2 and BIS were recorded at the time the patient entering operating room,the plasma concentration of sufentanil and fentanyl came into balance with effect-site concentration,the preset plasma concentration of propofol attained and right after tracheal intubation was accomplished (T4).Results The propofol EC50 at loss of consciousness was 4.13 μg/ml,and 3.58 μg/ml in each group,and the 95% confidence interval was 3.95 μg/ml-4.32 μg/ml and 3.39 μg/ml-3.76 μg/ml.Conclusions With the increase of target effect site concentration of sufentanil,the EC50 of propofol at loss of consciousness decreased.Sufentanil has stronger synergistic interaction with propofol compared with fentanyl.The equipotent dose between sufentanil and fentanyl changes with the intensity of stimulation at a range of (6-10):1.