瑞芬太尼用于咽反射敏感患者行口腔治疗的有效剂量测定

Effective dose of remifentanil for patients with severe gag reflex in dental treatment

目的采用序贯法测定瑞芬太尼抑制咽反射敏感的半数有效剂量(median effective dose,ED_(50))及95%有效剂量(95%effective dose,ED_(95))。方法本研究共纳入咽反射敏感患者35例,根据改良Dixon序贯试验法,首例患者靶控输注(TCI)瑞芬太尼,起始靶浓度设定为1.2 ng/ml,5 min后行咽反射抑制有效性测定,若抑制无效则下一位患者将瑞芬太尼初始靶浓度增加0.1 ng/ml,若抑制有效则将瑞芬太尼靶浓度减少0.1 ng/ml,直到出现7次折返停止试验。计算瑞芬太尼抑制患者咽反射敏感的ED_(50),ED_(95)和95%可信区间(CI)。结果瑞芬太尼抑制患者咽反射敏感的ED_(50)为1.36ng/ml(95%CI 1.14-2.12),ED_(95)为1.81ng/ml(95%CI 1.56-3.55)。与基础值(T_(0))相比,TCI瑞芬太尼5min(T_(1))时的心率(HR)、平均动脉压(MAP)、脉氧饱和度(SpO_(2))、脑电双频指数(BIS)及Ramsay镇静评分(RSS)无明显统计学差异(P>0.05)。结论靶控输注瑞芬太尼抑制咽反射敏感的ED_(50)为1.36 ng/ml,ED_(95)为1.81 ng/ml,患者呼吸循环稳定,临床使用可安全有效抑制咽反射,为咽反射敏感患者提供舒适化口腔治疗。

Objective To determine the 50%effective dose(ED_(50))and 95%effective dose(ED_(95))of remifentanil in management of gag reflex.Methods Thirty-five patients who experienced a severe gag response were included in this study.According to modified Dixon sequential method,the first patient was administered remifentanil with plasma concentration of 1.2 ng/ml by target-controlled infusion(TCI).After five minutes,the gag was assessed.If gag reflex of the previous patient occurred,the dose of remifentanil of the next patient increased by 0.1 ng/ml,otherwise decreased by 0.1 ng/ml.The test was terminated when the seven crossing points occurred.ED_(50),ED_(95)and corresponding 95%CI of remifentanil were calculated by probit regression analysis method.Results The ED_(50)of remifentanil eliminating gag reflex was 1.36 ng/ml(95%CI 1.14-2.12)and ED_(95)was 1.81 ng/ml(95%CI 1.56-3.55).Compared with T_(0)(basic value),heart rate(HR),blood pressure(BP),blood oxygen saturation of pulse(SpO_(2)),Bispectral index(BIS)and Ramsay sedation scale(RSS)in T_(1)(infusion remifentanil 10 min)were not significantly different(P>0.05).Conclusions The ED_(50)of remifentanil eliminating gag reflex was 1.36 ng/ml and ED_(95)was 1.81 ng/ml.Remifentanil can be used safely and effectively in patients with severe gag reflex.