布托啡诺对依托咪酯致患者意识消失作用的影响

Effects of butorphanol on ED95 of etomidate for loss of consciousness

目的:探讨15μg/kg布托啡诺对依托咪酯致患者意识消失95%有效剂量(ED95)的影响。方法:择期行无痛肠镜检查患者80例,性别不限,年龄42~60岁,美国麻醉医师协会(ASA)分级I或II级。将患者随机分为两组:依托咪酯组(E组)、依托咪酯复合布托啡诺15μg/kg组(EB组)。EB组患者予静脉注射重酒石酸布托啡诺15μg/kg,3 min后按偏性掷币序贯法给予依托咪酯,首剂量为0.04 mg/kg,相邻剂量差0.04 mg/kg,E组采用相同容量生理盐水代替,依托咪酯的给予方式与EB组相同。应用保序回归和合并相邻者算法计算依托咪酯致患者意识消失的ED95,通过Bootstrap重复抽样法计算95%CI。结果:E组依托咪酯致患者意识消失的ED95及其95%CI为0.220(0.190~0.262)mg/kg,EB组中依托咪酯致患者意识消失的ED95为0.159(0.125~0.179)mg/kg。EB组依托咪酯致患者意识消失的ED95明显低于E组(P<0.05)。EB组肌阵挛的发生率明显低于E组(P<0.05)。结论:预注布托啡诺15μg/kg可明显降低依托咪酯致患者意识消失的ED95,同时可降低依托咪酯所致肌阵挛的发生率。

Objective:To determine the effects of butorphanol of 15μg/kg on 95%effective dose(ED95)of etomidate for loss of consciousness.Methods:A total of 80 patients undergoing painless colonoscopy were studied,male or female,aged 42 to 60 years old,and American association of anesthesiologists(ASA)gradeⅠorⅡ.These patients were allocated to two groups in accordance with the random number table:etomidate alone(Group E),or etomidate combined with butorphanol of 15μg/kg for intravenous premedication(Group EB).For Group EB,15μg/kg of butorphanol were intravenously injected,and after 3 minutes the etomidate dosage was determined using the biased coin design up-and-down sequential method.The first dose of etomidate was 0.04 mg/kg,and the adjacent dose gradient was 0.04 mg/kg.For Group E,butorphanol was replaced by normal saline of the same volume,and the etomidate dosage was determined in the same way as Group EB.ED95 of etomidate for loss of consciousness of every group was determined by the isotonic regression with pooled adjacent violators algorithm separately.The bootstrap was used to estimate the confidence interval(95%CI)of ED95.Results:ED95 and the 95%CI of etomidate for loss of consciousness was 0.220(0.190-0.262)mg/kg in Group E,0.159(0.125-0.179)mg/kg in Group EB.The ED95 of etomidate for loss of consciousness in Group EB was significantly lower than that in Group E(P<0.05).Compared with Groups E,the incidence of myoclonus was lower in Group EB(P<0.05).Conclusion:Butorphanol of 15μg/kg for intravenous premedication can significantly reduce the ED95 of etomidate for loss of consciousness and the incidence of myoclonus.