复合丙泊酚时舒芬太尼抑制患儿硬支气管镜检查插管反应的半数有效剂量

Median effective dose of sufentanil blunting responses to rigid bronchoscopy in children combined with propofol

目的测定复合丙泊酚时舒芬太尼抑制患儿硬支气管镜检查插管反应的半数有效剂量(ED 50)。方法选择气管异物行硬支气管镜检查的患儿23例,男15例,女8例,年龄1~3岁,体重9~15 kg,ASAⅠ或Ⅱ级,MallampatiⅠ或Ⅱ级。麻醉诱导静脉注射舒芬太尼,初始剂量为0.3μg/kg,然后缓慢静脉注射丙泊酚3 mg/kg,患儿意识消失后,咽喉部利多卡因局部喷雾后行硬支气管镜检查,观察患儿对进镜反应情况。采用改良序贯法计算舒芬太尼的剂量,若在进镜时发生插管反应,则下一例患儿增加0.05μg/kg,否则降低0.05μg/kg,直至出现至少6个阳性反应和阴性反应交替的波形,结束试验。采用概率单位回归分析法计算舒芬太尼抑制患儿硬支气管镜检查时检查反应的ED 50、ED 95及其95%可信区间(CI)。结果舒芬太尼抑制患儿行硬支气管镜检查时插管反应的ED 50及其95%CI为0.168(0.124~0.202)μg/kg,ED 95及其95%CI为0.233(0.200~0.442)μg/kg。结论复合丙泊酚时舒芬太尼抑制患儿硬支气管镜检查时插管反应的ED 50为0.168(0.124~0.202)μg/kg。

Objective To determine the median effective dose of sufentanil blunting responses to rigid endotracheal intubation when combined with propofol.Methods Twenty-three children with foreign bodies in the trachea were selected for hard bronchoscopy,15 males and 8 females,aged 1-3 years,weighing 9-15 kg,falling into ASA physical statusⅠorⅡ,MallampatiⅠorⅡ.Sufentanil was injected intravenously with the initial dose of 0.3μg/kg,and then propofol 3 mg/kg slowly.Rigid bronchoscopy was performed after topical 2%lidocaine sprayed over epiglottis and glottic inlet after loss of consciousness and achieving sufficient depth of anesthesia.The children s reaction to endoscopy was obseved.The dose of sufentanil was determined by modified Dixon s up-and-down method and the adjacent dose gradient was 0.05μg/kg.The dose of sufentanil was increased or decreased by 0.05μg/kg in the next patient.At least 6 independent cross-over pairs were observed,and the test was completed.The ED 50,ED 95 and 95%confidence interval(CI)of sufentanil blunting the responses to rigid bronchoscopy were calculated using the modified sequential method.Results The ED 50(95%CI)and ED 95(95%CI)of sufentanil blunting the responses to rigid bronchoscopy in children were 0.168(0.124-0.202)μg/kg and 0.233(0.200-0.442)μg/kg,respectively.Conclusion When combined with propofol,ED 50 of sufentanil blunting the responses to rigid bronchoscopy in children is 0.168(0.124-0.202)μg/kg.