复合异丙酚时瑞芬太尼抑制维吾尔族患者气管插管及切皮反应的半数有效血浆浓度

Median effective plasma concentration of remifentanil inhibiting cardiovascular response to tracheal intubation and skin incision when combined with propofol in patients of Uighur nationality

目的确定复合异丙酚时瑞芬太尼抑制维吾尔族患者气管插管及切皮反应的半数有效血浆浓度（EC50）。方法择期拟行腹腔镜胆囊切除术维吾尔族患者30例，ASA分级Ⅰ或Ⅱ级，年龄20．60岁，体重指数18-30kg／m2。静脉输注异丙酚维持BIS值40—50时，TCI瑞芬太尼，初始Cp6．0ng／ml，待Ce与Cp达平衡后静脉注射顺式阿曲库铵0．2mg／kg，2min后行气管插管。患者气管插管后初始Cp为6．0ng／ml，待Ce与Cp达平衡后开始切皮。发生气管插管反应和（或）切皮反应，则下一例患者采用高一级浓度，否则采用低一级浓度，浓度梯度为0．5ng／ml。发生气管插管反应和（或）切皮反应的标准：收缩压升高超过基础值15％和（或）心率〉90次／min且持续时间〉15s。计算瑞芬太尼抑制气管插管及切皮反应的EC50及其95％可信区间（CI）。结果复合异丙酚维持BIS值40～50时瑞芬太尼抑制气管插管及切皮反应的EC50及其95％CI分别为3．4（2．3—4．5）ng／ml和3．8（2．8～4．9）ng／ml。结论复合异丙酚维持BIS值40-50时瑞芬太尼抑制维吾尔族患者气管插管及切皮反应的EC50分别为3．4和3.8ng／ml。

Objective To determine the median effective plasma concentration of remifentanil （EC50） inhibiting cardiovascular response to tracheal intubation and skin incision when combined with propofol in patients of Uighur nationality. Methods Thirty ASA Ⅰ or Ⅱ Uighurs aged 20-60 yr with body mass index of 18-30 kg/m2 undergoing elective laparoscopic eholecystectomy were enrolled in this study. Anesthesia was induced and maintained with pmpofol infusion. BIS value was maintained at 40-50. TCI of remifentanil was then started. The initial target plasma concentration （Cp） was 6.0 ng/ml. EC50 of remifentanil was determined by modified Dixon＇ s up- and-down sequential experiment. Each time Cp increased/decreased by 0.5 ng/ml. Tracheal intubation was facilitated with cisatracurium 0.2 mg/kg at 2 min after a new Cp was set when target effect-site concentration （Ce） was balanced with Cp. Positive cardiovascular response was defined as increase in SBP by 15% and/or HR 〉 90 bpm lastings〉 15 s. The EC50 （95% confidence interval） of remifentanil blunting responses to tracheal intubation and skin incision was calculated. Results EC50 （95 % confidence interval） of remifentanil inhibiting cardiovascular response to tracheal intubation and skin incision when combined with p ropofol was 3.4 （2.3-4.5） ng/ml and 3.8 （2.8-4.9） ng/ml respectively. Conclusion When depth of anesthesia was maintained at BIS value 40-50 with propofol infusion, the EC50 of remifentanil inhibiting cardiovascular response to tracheal intubation and skin incision is 3.4 and 3.8 ng/ml respectively.