不同剂量瑞马唑仑麻醉诱导对瑞芬太尼抑制气管插管反应的半数有效血浆靶浓度的影响

Effect of different doses of remimazolam on the median effective plasma target concentration of remifentanil in inhibiting response to endotracheal intubation

目的探讨麻醉诱导时不同剂量瑞马唑仑对瑞芬太尼抑制气管插管反应半数有效血浆靶浓度(Cp_(50))的影响。方法选择择期行气管插管全身麻醉手术患者79例,男14例,女65例,年龄18~60岁,BMI 18~30 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字法将患者分为三组:瑞马唑仑0.2 mg/kg(R1组)、0.3 mg/kg(R2组)和0.4 mg/kg(R3组)。根据分组分别静脉注射瑞马唑仑0.2、0.3、0.4 mg/kg进行麻醉诱导,待患者MOAA/S评分为0分时,将瑞芬太尼进行靶控输注(TCI)给药,3 min后行气管插管术。瑞芬太尼血浆靶浓度由序贯法确定,初始剂量为3.0 ng/ml,剂量梯度为0.2 ng/ml,并根据插管反应确定下一例患者瑞芬太尼剂量。记录入室后安静状态下、麻醉诱导后、气管插管后的HR、MAP、BIS。记录意识消失时间。采用Probit法计算Cp_(50)及95%可信区间(CI)。结果与入室后安静状态下比较,麻醉诱导后R1组HR明显增快、BIS明显降低(P<0.05),R2、R3组HR明显增快,MAP、BIS明显降低(P<0.05)。与R1组比较,R2、R3组意识消失时间明显缩短(P<0.05)。与R2组比较,R3组意识消失时间明显缩短(P<0.05)。R1、R2和R3组瑞芬太尼Cp_(50)和95%CI分别为4.23 ng/ml(95%CI 3.91~4.69 ng/ml)、3.55 ng/ml(95%CI 3.25~3.90 ng/ml)、3.42 ng/ml(95%CI 3.13~3.77 ng/ml)。与R1组比较,R2、R3组Cp_(50)明显降低(P<0.05)。结论瑞芬太尼抑制气管插管反应的Cp_(50)随着瑞马唑仑剂量的升高而降低。

Objective To investigate the effect of different doses of remimazolam on the median effective plasma target concentration(CP50)of remifentanil in inhibiting response to endotracheal intubation.Methods Seventy-nine patients underwent endotracheal intubation under general anesthesia,14 males and 65 females,aged 18-60 years,BMI 18-30 kg/m^(2),ASA physical statusⅠorⅡ,were randomly divided into three groups:remimazolam 0.2 mg/kg group(group R1),remimazolam 0.3 mg/kg group(group R2),remimazolam 0.4 mg/kg group(group R3).The patients received anesthesia induced by intravenous injection of remimazolam 0.2,0.3,and 0.4 mg/kg in groups R1,R2,and R3.When the MOAA/S score was 0,remifentanil was administered by TCI,and tracheal intubation is performed 3 minutes later.Dixon’s up-and-down sequential method was used to determine the plasma target concentration of remifentanil,with an initial concentration of 3.0 ng/ml and a concentration gradient of 0.2 ng/ml.The concentration of remifentanil in the next patient was determined according to whether responses to endotracheal intubation occurred.HR,MAP,and BIS were recorded in the quiet state after entering the operating room,after induction of anesthesia and after endotracheal intubation.The time of loss of consciousness was recorded.Cp_(50)and 95%confidence interval(CI)were calculated by Probit method.Results Compared with the quiet state after entering the operating room,HR was increased significantly and BIS was decreased significantly after anesthesia induction in group R1(P<0.05),and HR was increased significantly and MAP,BIS were decreased significantly after anesthesia induction in groups R2 and R3(P<0.05).Compared with group R1,the time of loss of consciousness was shorter in groups R2 and R3(P<0.05).Compared with group R2,the time of loss of consciousness was shorter significantly in group R3(P<0.05).The Cp_(50)and 95%CI of remifentanil were 4.23 ng/ml(95%CI 3.91-4.69 ng/ml),3.55 ng/ml(95%CI 3.25-3.90 ng/ml)and 3.42 ng/ml(95%CI 3.13-3.77 ng/ml)in groups R1,R2 and R3 respectively.Compared with group R1,Cp_(50)of remifentanil were significantly lower in groups R2 and R3(P<0.05).Conclusion The Cp_(50)of remifentanil inhibiting endotracheal intubation response decreased with the increase of the dose of remimazolam.