顺阿曲库铵用于输尿管镜下激光碎石术患者喉罩置入的剂量研究

Dose finding study of cisatracurium for laryngeal mask insertion in patients undergoing ureteroscopic laser lithotripsy

目的探讨顺阿曲库铵用于输尿管镜下激光碎石术患者喉罩置入的半数有效剂量(ED50)和95%有效剂量(ED95)。方法选取2020年1月至2021年2月拟于泰州市人民医院行输尿管镜下激光碎石术的50例患者。使用Dixon序贯法调整患者的顺阿曲库铵用药剂量,药物剂量梯度依次为0.15、0.125、0.1、0.075、0.05、0.025、0.0125 mg/kg。若上一例患者成功置入喉罩,下一例患者顺阿曲库铵剂量下调一个梯度;若上一例患者置入喉罩失败,下一例患者顺阿曲库铵剂量上调一个梯度。依照上述规则,直至纳入50例患者为止。记录各剂量顺阿曲库铵的总人数及喉罩置入成功人数用于计算ED50和ED95。依据ED50和ED95具体值及各剂量样本量情况,将顺阿曲库铵剂量0.05、0.025、0.0125 mg/kg依次设为顺阿曲库铵0.05 mg/kg组(C0.05组,8例)、顺阿曲库铵0.025 mg/kg组(C0.0125组,22例)、顺阿曲库铵0.0125 mg/kg组(C0.0125组,15例)。记录患者注射顺阿曲库铵前(T0)、注射顺阿曲库铵后3 min(T1)、喉罩置入后即刻(T2)的四个成串刺激(TOF),以及T2时点的气道峰压。记录术中喉罩移位及拔除喉罩后咽痛、喉罩染血、声音嘶哑、喉痉挛等不良反应发生情况。结果使用Probit回归计算ED50和ED95,结果显示顺阿曲库铵用于输尿管镜下激光碎石术患者喉罩置入的ED50和ED95分别为0.025 mg/kg(95%CI:0.010~0.030)和0.045 mg/kg(95%CI:0.030~0.060)。C0.0125组T1时点的TOF(T4/T1值)明显高于C0.025组和C0.05组患者,差异有统计学意义(P<0.05)。C0.025组T2时点的气道峰压明显高于C0.0125组和C0.05组,差异有统计学意义(P<0.05)。三组患者的术中喉罩移位、咽痛、声音嘶哑发生率比较,差异均无统计学意义(均P>0.05)。C0.05组的喉罩染血发生率低于C0.025组和C0.0125组,差异无统计学意义(P=0.063)。结论顺阿曲库铵用于输尿管镜下激光碎石术患者喉罩置入的ED50为0.025 mg/kg(95%CI:0.010~0.030)、ED95为0.045mg/kg(95%CI:0.030~0.060)。

Objective To evaluated the 50%effective dose(ED50)and 95%effective dose(ED95)of cisatracurium for laryngeal mask insertion in patients undergoing ureteroscopic laser litho-tripsy.Methods A total of 50 patients who planned to undergo ureteroscopic laser lithotripsy in our hospital from January 2020 to February 2021 were selected.Dixon sequential method was used to adjust the drug dose of cisatracurium,and the drug dose gradient was 0.15,0.125,0.1,0.075,0.05,0.025,0.0125 mg/kg.If the laryngeal mask was successfully inserted in the previous patient,the cisatracurium dose was lowered by a gradient in the next patient.If laryngeal mask placement failed in the previous patient,cisatracurium dose was increased by a gradient in the next patient.The total number of patients with cisatracurium at each dose and the number of successful laryngeal mask placement were recorded for calculation of ED50 and ED95.According to the values of ED50 and ED95 and the sample size of each dose,the doses of cisatracurium 0.05 mg/kg,0.025 mg/kg and 0.0125 mg/kg were divided into cisatracurium 0.05 mg/kg group(C0.05 group,8 cases),cisatracurium 0.025 mg/kg group(C0.025 group,22 cases)and cisatracurium 0.0125 mg/kg group(C0.0125 group,15 cases).Train of four stimulation(TOF)of patients were recorded before injection of cisatracurium(T0),3 min after injection of cisatracurium(T1),and immediately after laryngeal mask insertion(T2)and peak airway pressure at T2.The adverse reactions such as pharyngeal pain,blood stained laryngeal mask,hoarseness and laryngeal spasm after laryngeal mask removal were recorded.Results Probit regression was used to calculate ED50 and ED95,and the results showed that the ED50 and ED95 of laryngeal mask insertion with cisatracurium were 0.025 mg/kg and 0.045 mg/kg,respectively.TOF(T4/T1)at T1 in C0.0125 group was significantly higher than that in C0.025 group and C0.05 group,the difference was statistically significant(all P<0.05).The peak at T2 in the C0.025 group was significantly higher than that in the C0.0125 and C0.05 groups,and the difference was statistically significant(all P<0.05).There was no significant difference in the incidence of intraoperative laryngeal mask displacement,pharyngeal pain and hoarseness among the three groups(P>0.05).The incidence of blood stained laryngeal mask in C0.05 group was lower than that in C0.025 group and C0.0125 group,but the difference was not statistically significant(P=0.063).Conclusions The ED50 and ED95 of cisatracurium for laryngeal mask insertion in ureteroscopic laser lithotripsy were 0.025 mg/kg(95%CI:0.010-0.030)and 0.045 mg/kg(95%CI:0.030-0.060).