异丙酚辅助腰硬联合麻醉在腹腔镜疝修补术中气腹时患者体动反应的半数有效效应室靶浓度

The half-effective target effect-site concentration of propofol required to inhibit the body movement during pneumoperitoneum at totally extraperitoneal prosthesis under combined spinal-epidural anesthesia

目的：确定异丙酚辅助腰麻联合硬膜外麻醉（combined spinal-epidural anesthesia,CSEA）在建立气腹时患者体动反应的半数有效效应室靶浓度（EC50）。方法：选择异丙酚辅助行腹腔镜完全腹膜外疝修补术（totally extraperitoneal prosthesis,TEP）患者50例,性别不限,BMI〈30 kg/m2,ASAⅠ级或Ⅱ级,随机均分为S1组、S2组、S3组、S4组和S5组（n=10）,异丙酚效应室靶浓度分别1.0、1.5、2.0、2.5、3.0 ng/ml。患者意识消失建立腹膜外气腹后,压力维持10 mmHg,患者发生体动反应（咳嗽和吞咽动作除外）为阳性反应。采用Bliss法计算异丙酚辅助CSEA在TEP术中建立气腹时患者体动反应的EC50及其95%可信区间。结果：异丙酚辅助CSEA在TEP术中建立气腹时患者体动反应的EC50为2.23 ng/ml,95%可信区间1.80~3.31 ng/ml。结论：异丙酚辅助CSEA在腹腔镜TEP术中建立气腹时患者体动反应的EC50为2.23 ng/ml。

Objective：To determine the half-effective target effect-site concentration（EC50） of propofol required to inhibit the body movement during pneumoperitoneum at totally extraperitoneal prosthesis（TEP） under combined spinal-epidural anesthesia（CSEA）.Methods：Fifty ASA Ⅰ or Ⅱ patients of both sexes,BMI30 kg/m2,undergoing laparoscopic TEP were randomly divided into 5 groups according to the different target effect-site concentration of propofol（n=10）：group S1（1.0 ng/ml）,group S2（1.5 ng/ml）,group S3（2.0 ng/ml）,group S4（2.5 ng/ml）,group S5（3.0 ng/ml）.The pneumoperitoneum was established as soon as the patients lost consciousness,pneumoperitoneum pressure was about 10 mmHg.The response was defined as positive when body movement occurred（cough and swallowing were excluded）.The EC50 of propofol required to inhibit the body movement during 10 mmHg CO2 pneumoperitoneum and 95% confidence interval（CI） were calculated by Bliss method.Results：The EC50 of propofol required to inhibit the body movement during 10 mmHg CO2 pneumoperitoneum at laparoscopn TEP under CSEA is 2.23 ng/ml and 95% CI was 1.80-3.31 ng/ml.Conclusions：The EC50 of propofol required to inhibit the body movement during pneumoperitoneum at laparoscopic TEP under CSEA is 2.23 ng/ml.