帕瑞昔布钠对两种不同靶浓度瑞芬太尼输注下七氟醚MACBAR的影响

Effect of parecoxib sodium on MAC_(BAR) of sevoflurane under two target-controlled concentrations of remifentanil

目的观察帕瑞昔布纳对两种不同靶浓度瑞芬太尼输注下七氟醚阻断肾上腺素能反应最低肺泡气浓度(MACBAR)的影响。方法择期全麻行腹部手术患者80例,随机均分为四组:七氟醚+瑞芬太尼1ng/ml(A1组);七氟醚+瑞芬太尼3ng/ml(A3组);七氟醚+瑞芬太尼1ng/ml+帕瑞昔布钠0.8mg/kg(P1组);七氟醚+瑞芬太尼3ng/ml+帕瑞昔布钠0.8mg/kg(P3组)。依据HR或MAP变化序贯法观察七氟醚浓度改变。记录诱导前、切皮前2min、切皮后5min期间每分钟HR、MAP。序贯法半数效量公式计算每组七氟醚MACBAR。结果 A1、P1组七氟醚MACBAR分别为1.66%[95%可信区间(CI):1.31%～2.11%]和1.48%(95%CI:1.28%～1.72%),P1组较A1组减少11%(P<0.01);A3、P3组七氟醚MACBAR分别为0.32%(95%CI:0.26%～0.40%)和0.29%(95%CI:0.24%～0.35%),P3组较A3组减少9%。结论 1ng/ml瑞芬太尼靶控输注时,帕瑞昔布钠可减低七氟醚MACBAR的11%;而在3ng/ml靶控输注时,则可减低七氟醚MACBAR的9%。

Objective To determine the effect of parecoxib sodium on sevoflurane requirement for blunting adrenergic responses （MACBAR） after surgical incision under two different targetcontrolled concentrations of remifentanil. Methods Eighty patients with ASA Ⅰ or Ⅱ undergoing general anesthesia for elective abdominal surgery were randomly allocated into sevoflurane anesthesia and group with the addition of parecoxib sodium 0.8 mg/kg （n=40）. Both groups were sub-grouped into： 1 ng/ml remifentanil （groups A1 and P1）, or 3 ng/ml remifentanil （groups A3 and P3）. The end-tidal sevoflurane concentration and MAC for each group were determined using an up-and-down sequential allocation technique. Results The MACBAR of sevofiurane was 1.66% （95% CI： 1.31%-2.11%） in the group A1 and 1.48% （95% CI： 1.28%-1. 72%） in the group P1 （P〈0.01）, and 11% less the group P1 was than the group A1; while in the groups A3 and P3 the MACBAR of sevoflurane was 0. 32%（95% CI： 0.26G-0.40%o） and 0.29%0 （95% CI： 0.24%-0.35%）, respectively, and 9% less the group P3 was than the other. Conclusion Parecoxib sodium can reduce the MACBAR of sevoflurane by 11% and 9% when the target concentration of remifentanil was 1 ng/ml and 3 ng/ml, respectively.