合用咪达唑仑下舒芬太尼呼吸抑制的半数效应室靶浓度

Respiratory depressant half-effective target effect site concentration of sufentanil compounded with midazolam

目的:测定合用咪达唑仑下舒芬太尼引起呼吸抑制的半数效应室靶浓度(Ce50)。方法:择期全麻手术患者,年龄30～50岁,ASAⅠ～Ⅱ级,体质量指数(BMI)<30kg.m-2,以效应室靶质量浓度60μg.L-1靶控输注咪达唑仑,达到平衡后按序贯法靶控输注舒芬太尼20min,相邻效应室靶浓度之间比值为1.2。分别设为0.3,0.25,0.2,0.17,0.14μg.L-1,初始靶质量浓度0.2μg.L-1。若上一例患者未发生呼吸抑制,则应用高一级的效应室浓度;若发生呼吸抑制,则应用低一级的效应室浓度。根据呼吸频率、呼吸暂停时间、脉搏血氧饱和度、呼气末二氧化碳分压及动脉血气分析判定呼吸抑制。结果:舒芬太尼引起呼吸抑制的半数效应室靶质量浓度为0.19μg.L-1,95%的可信区间为0.17～0.21μg.L-1。结论:合用咪达唑仑下舒芬太尼引起呼吸抑制的半数效应室靶质量浓度为0.19μg.L-1,95%的可信区间为0.17～0.21μg.L-1。

OBJECTIVE To determine the half-effective target effect site concentration （Ce50） of sufentanil causing respiratory depression when compounded with midazolam. METHODS ASA class Ⅰ - Ⅱ patients aged 30 - 50 yr with body weight index （30 kg.m^-2 undergoing elective surgery under general anesthesia were enrolled in this study. The anesthesia was initiated by TCI of midazolam at the target effect site concentration of 60μg. L^-1. As soon as the balance was reached, TCI of sufentanil with the Bovill model was started from target effect-site concentration of 0. 2μg.L^-1. Ce50 was determined by up and down sequential test. The ratio of two successive target effect-site concentration was 1.2. Respiratory depression was defined as RR〈 8 bpm or/and apnea〉15 s or/and SpO2〈94% or/and PETCO2〉55 mmHG. RESULTS The Ce50 of sufentanil was 0. 19μg·L^-1 ,95% confidence interval was between 0. 17μg.L6-1 and 0. 21μg.L ^-1. CONCLUSION The Ce50 of sufentanil causing respiratory depression when compounded with midazolam was 0. 19 ng· mL^-1. 95% confidence interval was between 0. 17 μg· L^-1 and 0. 21 μg.L^-1.