芬太尼对丙泊酚靶控输注引起吞咽功能障碍的半数有效浓度的影响及相关研究

Effect of fentanyl on median effective plasma target concentration in patients with swallowing dysfunction induced by target-controlled infusion and related studies

目的探讨小剂量芬太尼对丙泊酚引起吞咽功能障碍的半数有效浓度(EC 50)的影响。方法选择我院2018-07/2019-02期间择期行全麻手术患者40例,ASA分级Ⅰ或Ⅱ级,年龄18~65岁,BMI 18~30 kg/m 2。按照择期手术时间的先后顺序将患者编号,并随机分为丙泊酚组(P组,n=20)和芬太尼+丙泊酚组(FP组,n=20)。采用序贯法确定2组的靶浓度,同时记录靶控输注前、靶控输注后达到效应室浓度时平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)、呼气末二氧化碳分压(PETCO2)。结果P组引起吞咽功能障碍的EC50为2.81μg/mL(95%CI 2.51~3.57μg/mL),FP组引起吞咽功能障碍的EC 50为1.85μg/mL(95%CI 1.48~2.30μg/mL),FP组明显低于P组(P<0.05)。两组患者在靶控输注后MAP、HR、SpO2都有不同程度的下降(P<0.05),PETCO2明显升高(P<0.05)。结论静脉注射小剂量芬太尼能降低丙泊酚引起吞咽功能障碍的靶控浓度,单纯输注丙泊酚或合用小剂量芬太尼达到引起吞咽功能障碍的EC50时,均已对呼吸和循环产生抑制作用。

Objective To investigate the effect of low dose fentanyl on median-effective target plasma concentration(EC50)in patients with swallowing dysfunction induced by target-controlled infusion(TCI).Methods Forty patients undergoing elective surgery under general anesthesia,American Society of Anesthesiologists physical status beingⅠorⅡ,aged 18-65 years,BMI 18-30 kg/m^2,in the First Affiliated Hospital of Shandong First Medical University from July 2018 to February 2019 were included and randomly divided into two groups,propofol group(group P,n=20)and fentanyl-propofol group(group FP,n=20).The up-and-down sequences were analyzed by using the Dixon and Massey method to determine the EC50 and mean arterial pressure(MAP),heart rate(HR),SpO2,PETCO2 before and after the drug infusion were recorded.Results The EC 50 of propofol for inhibition of the swallowing reflex was 2.81μg/mL(95%CI 2.51-3.57μg/mL)in group P while the EC50 of propofol was decreased to 1.85μg/mL(95%CI 1.48-2.30μg/mL)in group FP(P<0.05).During propofol-TCI,the MAP,HR,SpO2 were decreased and the PET CO2 increased in both groups(P<0.05).Conclusion Intravenous injection of low-dose fentanyl can reduce the target concentration of propofol which can induce dysphagia dysfunction.When the level of EC50 reaches the point that that dysphagia dysfunction occurs,propofol infusion alone or combined with low-dose fentanyl have had effects on breathing and circulation inhibition.