基于伤害敏感指数判定右美托咪定超前镇痛下舒芬太尼用于腹腔镜胆囊切除手术患者的半数有效剂量研究

Median effective dose of sufentanil for patients undergoing laparoscopic cholecystectomy under dexmedetomidine preemptive analgesia condition based on index of consciousness 2

目的 基于伤害敏感指数(index of consciousness 2, IoC2)探讨右美托咪定(dexmedetomidine, Dex)超前镇痛条件下舒芬太尼用于腹腔镜胆囊切除手术患者的半数有效剂量(median effective dose, ED50)。方法 选取2023年3—6月首都医科大学宣武医院行全麻下腹腔镜胆囊切除手术患者28例。利用序贯法将患者分为1.00μg/kg组(1例)、0.83μg/kg组(1例)、0.69μg/kg组(4例)、0.58μg/kg组(10例)、0.48μg/kg组(9例)及0.40μg/kg组(3例)。以1.5μg/(kg·h)持续泵入Dex 15 min超前镇痛后,行舒芬太尼诱导,诱导后继续持续输注15 min后开始切皮,切皮时以IoC2 <60为镇痛阈值,通过Dixon上下法增加/减少舒芬太尼剂量用以最终判定舒芬太尼的ED50及其95%CI,并分析术中血流动力学变化、术后24 h及48 h患者的视觉模拟评分(visual analog scale score, VAS)、恶心呕吐不良反应发生率。结果 28例患者中,男15例,女13例,年龄30~64岁,平均(52.8±10.5)岁。基于IoC2判定在右美托咪定超前镇痛条件下的ED50为0.4548μg/kg(95%CI:0.4335~0.4714)。0.58组术后12 h VAS低于0.40组,差异有统计学意义(P<0.05)。其余各组在术后12 h和24 h的VAS、3个关键时间点(T1,入室基础值;T2,麻醉诱导时;T3,切皮时)的血流动力学参数(SBP、DBP、MAP和HR)及术后恶心呕吐发生率的比较,差异均无统计学意义(P>0.05)。结论 基于IoC2 Dex超前镇痛下舒芬太尼用于腹腔镜胆囊切除手术患者全麻诱导镇静的ED50为0.4548μg/kg,镇静效果满意,无明显不良反应。

Objective To explore the median effective dose(ED_(50))of sufentanil for patients undergoing laparoscopic cholecystectomy under dexmedetomidine(Dex)preemptive analgesia based on the index of consciousness 2(IoC2).Methods A total of 28 patients underwent laparoscopic cholecystectomy in Xuanwu Hospital,Capital Medical University from March to June,2023 were selected,and were divided into 1.00μg/kg group(one case),0.83μg/kg group(one case),0.69μg/kg group(four cases),0.58μg/kg group(10 cases),0.48μg/kg group(nine cases)and 0.40μg/kg group(four cases)by sequential method.After pumping Dex at 1.5μg/(kg·h)for 15 min for preemptive analgesia,sufentanil was induced,and skin incision was started after continuous infusion for 15 min after induction,with IoC2<60 as the analgesic threshold,and the ED_(50) and 95%CI of sufentanil were finally determined by increasing/decreasing the dosage of sufentanil by Dixon up-and-down method.The hemodynamic changes during operation,visual analog scale score(VAS)of patients at 24 h and 48 h after operation,and the incidence of nausea and vomiting were analyzed.Results Among the 28 patients,there were 15 males and 13 females,aged from 30 to 64 years,with an average of(52.8±10.5)years.The ED_(50) under the condition of preemptive analgesia was judged to be 0.4548μg/kg(95%CI:0.4335-0.4714)based on IoC2.The VAS of 0.58 group was lower than that of 0.40 group at 12 h after operation,and the difference was statistically significant(P<0.05).There were no significant difference among the other groups of the VAS at 12 h and 24 h,the hemodynamic parameters(SBP,DBP,MAP and HR)at three key time points(T1,the basic value of admission;T2,during anesthesia induction;T3,postoperative period)and the incidence of nausea and vomiting(P>0.05).Conclusions The ED_(50) of sufentanil for general anesthesia induced sedation in patients undergoing laparoscopic cholecystectomy under preemptive analgesia with Dex is 0.4548μg/kg based on IoC2,and the sedation effect is satisfactory without obvious adverse reactions.