右美托咪啶对瑞芬太尼抑制切皮体动反应量效关系的影响

Effect of dexmedetomidine on relationship of remifentanil dose and inhibition of body movement following skin incision

目的评价右美托咪啶对瑞芬太尼抑制切皮体动反应量效关系的影响。方法 150例行择期乳房肿瘤切除术患者随机分为3组:瑞芬太尼组(R组)、右美托咪啶0.5μg.kg-1+瑞芬太尼组(D1R组)和右美托咪啶1.0μg.kg-1+瑞芬太尼组(D2R组),每组50例,D1R和D2R组分别输注右美托咪啶0.5和1.0μg.kg-1,持续时间为15 min,R组则泵注生理盐水。将每组患者随机分为5个亚组,每亚组10例,在输注右美托咪啶或生理盐水结束后效应室靶控不同浓度的瑞芬太尼。所有患者在靶控瑞芬太尼的同时效应室靶控输注丙泊酚3mg.L-1,3 min后切开乳房皮肤3 cm,观察患者有无体动反应。用Probit法计算抑制体动反应瑞芬太尼的5%有效效应室浓度(EC5),半数有效效应室浓度(EC50)和95%有效效应室浓度(EC95)及其各自95%可信区间(95%CI)。结果D1R和D2R组EC5、EC50和EC95均低于R组(P<0.0167),D2R组EC5、EC50和EC95低于D1R组(P<0.0167)。结论右美托咪啶剂量依赖性的减少抑制体动反应所需的瑞芬太尼剂量。

Objective To evaluate the effect of dexmedetomidine on relationship of remifentanil dose and inhibition of body movement following skin incision. Methods One hundred and fifty patients scheduled for mammary neoplasms surgery were randomly allocated to three groups： remifentanil group （group R） and dexmedetomidine 0. 5 μg.kg-1, ＋ remifentanil （group DI R） and dexmedetomidine 1.0 μg.kg-1, ＋ remifentanil（group DzR） （50 in each）. Dexmedetomidine 0.5 and 1.0μg.kg-1, and saline were intravenously infused for 15 minutes in group D1 R, D2R and R,respectively. Patients in each group were randomly assigned to five subgroups （10 in each）. Remifentanil was effect -site target -controlled infused following completion of dexmedetomidine and saline infusion and the concentration was set according to different subgroups. Propofol was effectsite targetcontrolled infused and the concentration was set at 3 mg · L-1 in all patients of three groups when remifentanil was administered. Three minutes after remifentanil and propofol administration, a 3 cm incision was made by surgeon and body movement was judged. By applying probit analysis, the effect - site concentration of remifentanil at which 5% （EC5） , 50% （ECs0） and 95% （EC95） of patients didn＇t show body movement during skin incision for each group were calculated. Results The EC5 , ECs0 and EC95 of remifentanil in group D2R and D2R were significantly lower than group R （P 〈 0.0167 ）. The EC5 , EC50 and EC95 of remifentanil in group D2 R were significantly decreased compared to group D2 R （P 〈 0. 0167 ）. Conclusion Dexmedetomidine attenuate remifentanil dose for preventing body movement in a dose -depended matter.