右美托咪啶复合靶控输注异丙酚时舒芬太尼抑制双腔气管插管反应的量效关系

Dose-response relationship of sufentanil blunting responses to double-lumen endotracheal intubation when combined dexmedetomidine and propofol by target-controlled infusion

目的确定右美托咪啶复合靶控输注（TCI）异丙酚时舒芬太尼抑制双腔气管插管反应的效应室靶浓度（EC50和EC95）。方法单肺通气全麻胸外科手术患者30例，ASA分级Ⅱ或Ⅱ级，年龄40—64岁，体重指数〈30kg/m2。经10min静脉输注右美托咪啶0．6μg／kg，随后以0．3μg·kg-1·h-1的速率维持至手术结束前30min。TCI舒芬太尼3min后TCI异丙酚，Ce3μg／ml，意识消失时静脉注射罗库溴铵0．8mg／kg行双腔气管插管。采用序贯法进行试验，TCI舒芬太尼初始Ce0．3ng／ml，如果前一例患者发生气管插管反应，则下一例患者采用高一级浓度，否则采用低一级浓度，相邻靶浓度之间比率为1．1。气管插管反应的标准：气管插管后3min内MAP波动幅度超过基础水平15％和，或HR〉90次／min。采用概率单位回归分析法计算舒芬太尼抑制双腔气管插管反应的EC50和EC50结果舒芬太尼抑制双腔气管插管反应的EC50为0．23ng／ml，其95％可信区间为0．20—0．26ng／ml；抑制双腔气管插管反应的EC95为0．26ng／ml，其95％可信区间为0．24～0．31ng／ml。结论右美托咪啶复合TCI异丙酚时，舒芬太尼抑制双腔气管插管反应的EC50和EC95分别为0．23和0．26ng／ml。

Objective To determine-the target effect-site concentration （ECs0 and EC95 ） of sufentanil blunting the responses to double-lumen endotracheal intubation when combined dexmedetomidine and propofol by target-controlled infusion （TCI） .Methods Thirty ASA Ⅰor Ⅱ patients aged 40-64 yr with body mass index 〈 30 kg/m2 undergoing thoracic surgery under general anesthesia. Dexmedetomidine 0.6 μg/kg was infused iv over 10 rain followed by continuous iv infusion at 0.3 μg·kg-1·h-1until 30 rain before the end of operation. The initial target effectsite concentration of sufentanil was set at0. 3 ng/ml, and the ratio of two consecutive effectsite concentrations was 1.1. Propofol was administered by TCI at an effect-site concentration of 3 μg/ml. When the patients lost eoneiousness, roeuronium 0.8 mg/kg was administrated. The responses to double-lumen endotracheal intubation was defined as the increase in MAP≥ 15 % of the baseline values and/or HR 〉 90 bpm within 3 rain after tracheal intubation. The ECs0 and ECgs （95% confidence interval） of snfentanil blunting the responses to double-lumen endotracheal intubation were calculated by Probit analysis. Results The ECs0 and EC95 of snfentanil blunting the responses to double-lumen endotracheal intubation were 0.23 ng/ml （95% CI 0.20-0.26 ng/ml） and 0.26 ng/ml （950/o CI 0.24-0.31 ng/ml）. Conclusion The EC50 and EC95 of snfentanil blunting the responses to double-lumen endotracheal intubation when combined dexmedetomidine and propofol by TCI are 0.23 and 0.26 ng/ml respectively.