右美托咪啶对舒芬太尼抑制老年患者腹部手术切皮时体动反应的EC50的影响

Dexmedetomidine to Sufentanil Inhibition of Elderly Patients with Abdominal Surgery when Cutting Leather EC50 of Dynamic Response

目的：探讨右美托咪啶对舒芬太尼抑制老年患者腹部手术切皮时体动反应的半数有效效应室靶浓度（ EC50）的影响。方法择期行腹部手术患者50例，性别不限，年龄60～65岁，体重50～70kg，ASA分级Ⅰ级或Ⅱ级，随机分为右美托咪啶组（D组）和对照组（C组）。 D组用右美托咪啶0．5μg/mg加入20ml生理盐水10min内静脉泵注，C组用等量生理盐水静脉泵注。舒芬太尼靶控浓度从0．20μg/L开始，相邻靶浓度之间的比率为1．2。先行输注舒芬太尼，待其效应室浓度达0．07～0．09μg/L后开始输注丙泊酚，血浆靶浓度为2．4mg/L。达平衡后给予司考林1．5mg/kg，90s后插管（气管导管及声门充分表麻）接麻醉呼吸机行机控呼吸，10min后切皮，记录切皮1min内有无体动反应。然后静脉注射0．6mg/kg罗库溴铵，继续进行手术。记录切皮时各组舒芬太尼用量和患者有无体动反应。结果 D组19例入选，C组18例入选。 D组和C组各有7例患者切皮时出现体动反应。 D组舒芬太尼抑制切皮时体动反应的EC50为0．1148μg/L，95％可信区间为0．1055～0．1249μg/L；C组舒芬太尼抑制切皮时体动反应的EC50为0．1454μg/L，95％可信区间为0．1339～0．1580μg/L，D组比C组减少21％（P＜0．05）。结论手术前缓慢静脉注射0．5μg/kg右美托咪啶可显著减少舒芬太尼抑制老年患者腹部手术切皮时体动反应的半数有效浓度和舒芬太尼的用量。

Objective Approach the effects of dexmedetomidine on half-effective target effect-site concentration of Sufentanil to inhibit body movement in elderly patients at the beginning of abdominal operation .Methods ASAⅠorⅡpatients （50 cases） of both sexes aged 60~65 years weighted 50~70kg undergoing abdominal operation were randomly divided into 2 groups：Dexmedetomidine（D） group re-ceived intravenous infusion of dexmedetomidine at 0.5μg/mg diluted into physiological saline 20ml respectively,the control group（C） was infused with physiological saline 20ml.Both groups（D and C） were finished in 10 minutes.The concentration of Sufentanil target-controlled was fixed at 0.20μg/L and the ratio of two close effect concentrations was 1.2.Infuse Sufentanil first and infuse Propofol when the effect-site concentration reached 0.07~0.09μg/L.The target plasma concentration was fixed at 2.4μg/mg.After the balance,infuse Scoline 1.5mg/kg.Intubate after 90 second （ Tracheal tube and glottis fully anesthetized ） and use controlled breathing with Anesthesia Ventilators .Opera-tions began after ten minutes and record the amount of body movement in the first minute .Then infuse Rocuronium 0.6mg/kg and continue the operation.Blood pressure,heart rate,SpO2,BIS value and the amount of body movement in every group were monitored .Results The EC50 of sufentanil in Dexmedetomidine group was 0.1148μg/L with 95%confidence level of 0.1055~0.1249μg/L,The EC50 of Sufentanil in control group was 0.1454μg/L with 95%confidence level of 0.1339~0.1580μg/L.Conclusion The dose of Sufentanil used in Dexme-detomidine group reduced about 21%than the control group .The dose of Sufentanil used in thyroidectomy obviously reduced with the Dexme-detomidine was given ,and the hemodynamicis was more stable during the operation .