靶控输注氯胺酮抑制气道高反应患者气管插管的半数有效效应室浓度

Median effective target effect-site concentration of Ketamine required for inhibitining intubation-induced airway hyperresponsiveness in patients

目的：探讨复合靶控输注（TCI）氯胺酮抑制气道高反应性（AHR）患者全身麻醉插管所需的半数有效效应室浓度（EC50）。方法：选择合并AHR的择期手术患者60例为研究对象,随机分为试验组（A组）和对照组（N组）,每组30例。N组采用TCI异丙酚[效应室靶控浓度（Ce）3.0μg/ml]和瑞芬太尼（Ce 3.1 ng/ml）,静脉滴注维库溴铵0.1 mg/kg等全身麻醉诱导插管;A组在N组的基础上复合TCI氯胺酮全身麻醉诱导插管,观察两组患者气管插管期间气道压（Paw）的变化等情况。结果：两组患者Paw、气管插管后2 min（T2）SBP和SpO2、气管插管后3 min（T3）ETCO2和SpO2比较差异有统计学意义（P〈0.05）,其余各时点数据比较差异无统计学意义（P〉0.05）。结论：AHR患者在缓解期间行全身麻醉插管时,TCI氯胺酮抑制AHR所需的半数有效效应室浓度EC50为1.13μg/ml,95%可信区间（CI）为0.97-1.28μg/ml。

Objective To investigate the median effective target effect-site concentration（EC50）of Ketamine required for inhibitining intubation-induced airway hyperresponsiveness（ AHR）in patients. Method 60 patients undergoing elective Operation with airway hyper-responsiveness were divided into A and N groups,with 30 patients per group. N group adopted the target effect-site concentration（ Ce）of propofol（3. 0μg/ml）and remifentanil（3. 1 ng/ml）target-controlled infusion and iv injection of vecuronium 0. 1 mg/kg. Tracheal intuba-tion was performed after the Ce and Cp were balanced. A group adopted the raised process of initial target plasma concentration of drug （ Cp）of ketamine was set at 1. 0μg/ml. Comparisons were conducted on the airway hyperresponsiveness the two groups,etc. Results There was significant difference on the Paw between the two groups（P﹤0. 05）. on the time T2,the levels of SBP was significantly higher in group N than that of group A（P﹤0. 05）. on the time T2 and T3,the levels of Spo2 was significantly lower in group N than that of group A（P﹤0. 05）. on the time T3,the levels of ETCO2 was significantly higher in group N than that of group A（P﹤0. 05）. There were not significant difference in other data between the two groups（ P﹥0. 05）. Conclusion In remission stage,the EC50 of ketamine inhibiting AHR to tra-cheal intubation in patients is 1. 13 μg/ml,95% confidence interval are 0. 97~1. 28 μg/ml.