靶控输注丙泊酚时舒芬太尼抑制肺结核患者双腔气管导管插管反应的量效关系

Dose-response relationship of sufentanil blunting responses to double-lumen endotracheal intubation when combined with propofol given by TCI in patients with pulmonary tuberculosis

目的确定靶控输注丙泊酚时舒芬太尼抑制肺结核患者双腔气管导管插管反应的量效关系。方法择期全麻下行胸科手术的肺结核患者100例，ASA分级Ⅰ或Ⅱ级，性别不限，年龄24～58岁，体重指数〈30 kg/m2，Mallampati气道分级Ⅰ或Ⅱ级，采用随机数字表法分为5组（n＝20）：Ⅰ-Ⅴ组麻醉诱导分别静脉注射舒芬太尼0.35、0.40、0.45、0.50、0.55 μg/kg，靶控输注丙泊酚（血浆靶浓度3.5 μg/ml），静脉注射维库溴铵0.15 mg/kg，双腔气管导管插管后机械通气。双腔气管导管插管后5 min内MAP升高〉基础水平20%和/或HR〉90次/min，为气管插管反应阳性。采用Probit法计算舒芬太尼抑制肺结核患者双腔气管导管插管反应的半数有效剂量（ED50），95%有效剂量（ED95）及其95%可信区间（95%CI）。结果靶控输注丙泊酚时舒芬太尼抑制肺结核患者双腔气管导管插管反应的ED50为0.411 μg/kg，95% CI为0.370～0.441 μg/kg，ED95为0.635 μg/kg，95% CI为0.556～0.888 μg/kg。结论靶控输注丙泊酚（血浆靶浓度3.5 μg/ml）时舒芬太尼抑制肺结核患者双腔气管导管插管反应的ED50为0.411 μg/kg，ED95为0.635 μg/kg。

Objective To determine the dose-response relationship of sufentanil blunting responses to double-lumen endotraeheal intubation when combined with propofol given by target-controlled infusion （TCI） in patients with pulmonary tuberculosis. Methods One hundred patients of both sexes with pulmonary tuberculosis, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , aged 24-58 yr, with body mass index 〈30 kg/m2, with Mallampati grade I or Ⅱ , undergoing thoracic surgery under general anesthesia, were divided into Ⅰ -Ⅴ groups （n = 20 each） using a random number table. Anesthesia was induced with iv sufentanil 0.35 p,g/kg （group Ⅰ ） , 0. 40 μg/kg （ group Ⅱ ） , 0.45 μg/kg （group Ⅲ ） , 0. 50 μg/kg （group Ⅳ ） and 0. 55 μg/kg （group Ⅴ ） , and propofol TCI （target plasma concentration 3.5 μg/ml） and iv veeuronium 0. 15 mg/kg. The patients were endotracheally intubated and mechanically ventilated. The response to double-lumen endotracheal intubation was defined as positive when mean arterial pressure increased by〉 20% of the baseline value and/or heart rate 〉 90 bpm within 5 min after intubation. The median effective dose （ED50） , ED95 and 95% confidence interval （95% CI） of sufentanil blunting the responses to double-lumen endotraeheal intubation were calculated by Probit analysis. Results The ED50 （95% CI） and ED95 （95% CI） of sufentanil blunting the responses to intubation were 0. 411 （0. 370- 0. 441） μg/kg and 0. 635 （0. 556-0. 888） μg/kg, respectively, when combined with propofol given by TCI. Conclusion When combined with propofol given by TCI （target plasma concentration 3.5 μg/ml）,the ED50 and ED95 of sufentanil blunting the responses to double-lumen endotracheal intubation are 0. 411 and 0. 635 μg/kg, respectively, in patients with pulmonary tuberculosis.