瑞芬太尼靶控输注用于日间妇科手术清醒镇静的半数有效浓度

EC_(50) of remifentanil target-controlled infusion for conscious sedation in daytime gynecological surgery

目的测定日间妇科手术患者复合丙泊酚靶控输注达到满意清醒镇静状态时的瑞芬太尼半数有效浓度(EC_(50))。方法择期选择行日间妇科手术患者36例,丙泊酚靶控浓度恒定在2.0μg/ml,瑞芬太尼初始靶控浓度为6 ng/ml。根据双盲、序贯方法,下一例患者瑞芬太尼靶控浓度根据上一患者清醒镇静满意或不满意进行增减,相邻浓度变化区间为0.2 ng/ml。通过probit analysis概率单位回归分析得出瑞芬太尼用于日间妇科手术患者清醒镇静的EC_(50)和95%有效浓度(EC_(95))。同时,记录患者手术期间呼吸、循环抑制,不良记忆等事件的发生情况。结果复合2.0μg/ml丙泊酚效应室靶控输注,瑞芬太尼用于日间妇科手术患者清醒镇静EC_(50)为5.43 ng/ml(95%CI 4.90～6.79 ng/ml),EC_(95)为6.42 ng/ml(95%CI 5.88～27.33 ng/ml)。其中有2例患者出现呼吸遗忘和体动反应并存的情况。结论复合丙泊酚效应室靶控输注2.0μg/ml时,瑞芬太尼靶控输注用于日间妇科手术患者清醒镇静推荐初始剂量为5.43 ng/ml。

Objective To determine the effect-site concentration of remifentanil combined with propofol target-controlled infusion in patients undergoing daytime gynecological surgery to keep conscious sedated in 50 percent of patients(EC50).Methods Thirty-six female patients undergoing daytime gynecological surgery were enrolled in this study.The propofol effect-site concentration was fixed at 2.0μg/ml in all patients.The initial remifentanil effect-site concentration was 6 ng/ml.According to the double blind and Dixon’s up and down method,the target-controlled concentration of remifentanil in the next patient was increased or decreased according to the satisfaction or dissatisfaction of the previous patient’s conscious sedation.The EC50 and EC95 of remifentanil for conscious sedation were determined using probit analysis.Adverse events in circulatory,respiratory systems and memory impairment was recorded.Results The EC50 of remifentanil that provides conscious sedation combined with 2.0μg/ml propofol was 5.43 ng/ml(95%CI 4.90~6.79 ng/ml),while the EC95 was 6.42 ng/ml(95%CI 5.88~27.33 ng/ml).During the study,2 patients occurred breath forgetting combined with body movement.Conclusions We suggest the target-controlled infusion concentration of remifentanil begins from 5.43 ng/ml to execute the sedation protocol with 2.0μg/ml propofol.