右美托咪定联合瑞芬太尼对中期妊娠引产术患者镇静的ED50影响

The sedation effects of dexmedetomidine combined with remifentanil in induction of labor in midpregnancy

目的探索右美托咪定复合瑞芬太尼在中期妊娠患者引产术镇静的最小有效剂量(ED50)。方法选择年龄18~45岁,ASAⅠ或Ⅱ级的产妇参加本实验。给予瑞芬太尼负荷剂量0.5μg/kg,持续泵注剂量0.05μg·kg^-1·min^-1,同时泵注右美托咪定,初始剂量0.2μg·kg^-1·h^-1,给药后26分钟评估产妇的镇静深度,通过改良序贯法来确定右美托咪定的剂量,若上一例产妇意识抑制阳性,则下一例产妇药物剂量减少0.05μg·kg^-1·h^-1,反之增加0.05μg·kg^-1·h^-1,直至研究结果出现7个意识抑制阴性转阳性的转折点,研究结束。意识抑制阳性定义为:睫毛反应消失,Ramsay评分4级,BIS值≤70。结果共有26例产妇参加研究,右美托咪定用于中期妊娠引产患者出现意识抑的ED50、ED95及其95%CI分别为0.39μg·kg^-1·h^-1(0.32~0.61μg·kg^-1·h^-1)、0.62μg·kg^-1·h^-1(0.48~1.95μg·kg^-1·h^-1)。结论右美托咪定复合瑞芬太尼用于中期妊娠引产术患者镇静的半数有效剂量为0.39μg·kg^-1·h^-1。

Objective To investigate the minimum effective dosage(ED50)of dexmedetomidine combined with remifentanil in induction of labor in midpregnancy.Methods The pregnant women aged 18~45 years with ASAⅠorⅡlevel were enrolled in the study.The pregnant women were given reminfentanil at load dosage of 0.5μg/kg,and continuous pumping dosage of 0.05μg·kg^-1·min^-1,at the same time,the dexmedetomidine was pumped with the initial dosage of 0.2μg·kg^-1·h^-1.At 26 minutes after administration,the sedation deepness of puerpera was evaluated.The following dosage of dexmedetomidine was determined by modified sequential method.If the previous parturient was positive in conscious suppression,the dosage for the next parturient was decreased by 0.05μg·kg^-1·h^-1,otherwise the dosage was increased by 0.05μg·kg^-1·h^-1,until 7 transition points appeared from negative to positive in conscious suppression,and the study was over.The definition of positive conscious suppression was the disappearance of eyelid reflex,Ramsay sedation score of 4,and BIS value≤70.Results A total of 26 puerpera participated in the study.The ED50,ED95 and 95%CI of dexmedetomidine induced conscious suppression were 0.39μg·kg^-1·h^-1(0.32~0.61μg·kg^-1·h^-1),and 0.62μg·kg^-1·h^-1(0.48~1.95μg·kg^-1·h^-1),respectively.Conclusion The ED50 of dexmedetomidine combined with remifentanil for sedation in induction of labor in midpregnancy is 0.39μg·kg^-1·h^-1.