复合丙泊酚时瑞芬太尼抑制妇科腹腔镜手术患者气腹反应的半数有效血浆靶浓度

详细信息    查看全文 | 推荐本文 |

英文篇名：Median effective plasma concentration of remifentanil inhibiting cardiovascular response to CO_2 pneumoperitoneum stimulus when combined with propofol in patients undergoing laparoscopic gynaecological surgery 作者：刘春宏 ; 尹利群 ; 刘夏曦 ; 胡庆波 ; 王中清 英文作者：LIU Chunhong;YIN Liqun;LIU Xiaxi;HU Qingbo;WANG Zhongqing;Department of Anesthesiology,Huainan Chaoyang Hospital; 关键词：瑞芬太尼 ; 丙泊酚 ; 腹腔镜手术 ; 半数有效血浆靶浓度 英文关键词：Remifentanil;;Propofol;;Laparoscopic surgery;;Median effective plasma concentration 中文刊名：LCMZ 英文刊名：Journal of Clinical Anesthesiology 机构：安徽省淮南朝阳医院麻醉科; 出版日期：2019-01-15 出版单位：临床麻醉学杂志 年：2019 期：v.35 语种：中文; 页：LCMZ201901008 页数：3 CN：01 ISSN：32-1211/R 分类号：28-30

摘要

目的确定复合丙泊酚时瑞芬太尼抑制妇科腹腔镜手术患者气腹反应的半数有效血浆靶浓度(median effective plasma concentration,Cp50)。方法择期拟行妇科腹腔镜手术患者22例,年龄20～60岁,BMI 18～30kg/m2,ASAⅠ或Ⅱ级。麻醉诱导采用靶控输注(TCI)瑞芬太尼和丙泊酚,对应血浆靶浓度(Cp)分别为5ng/ml和4μg/ml,静脉注射罗库溴铵0.6mg/kg。气管插管后稳定3min,调整瑞芬太尼Cp,第1例患者为6ng/ml,待效应室靶浓度与Cp平衡后建立气腹。发生气腹反应时,下一例采用高一级浓度,否则采用低一级浓度,浓度梯度的比值为1.2。发生气腹反应的标准:建立气腹后3min内HR增快和/或MAP升高幅度超过基础值的20%。计算复合丙泊酚时瑞芬太尼抑制妇科腹腔镜手术患者气腹反应的Cp50及其95%CI。结果复合丙泊酚时瑞芬太尼抑制妇科腹腔镜手术患者气腹反应的Cp50及其95%CI为4.58(4.14～5.08)ng/ml。结论复合丙泊酚时瑞芬太尼抑制妇科腹腔镜手术患者气腹反应的Cp50为4.58ng/ml。
        Objective To determine the median effective plasma concentration(Cp50)of remifentanil inhibiting cardiovascular response to CO2 pneumoperitoneum stimulus when combined with propofol in patients undergoing laparoscopic gynaecological surgery.Methods Twenty-two female patients scheduled for elective laparoscopic gynaecological surgery under general anesthesia,aged20-60 years,with a BMI 18-30 kg/m2,falling into ASA physical statusⅠ orⅡ,were enrolled in this study.Anesthesia was induced with propofol and remifentanil target-controlled infusion and iv injection of rocuronium 0.6 mg/kg.The target plasma concentration(Cp)of remifentanil and propofol were set at 5 ng/ml and 4μg/ml respectively.3 minutes after endotracheal intubation,the Cp of remifentanil was adjusted.The target Cp was set at 6 ng/ml in the first patient.CO2 pneumoperitoneum was performed after the target effect-site concentration and Cp were balanced.Each time Cp increased/decreased by 20%in the next patient depending on whether or not the cardiovascular response to CO2 pneumoperitoneum occurred.The positive cardiovascular response was defined as HR and/or MAP increasing by 20% within 3 minutes after CO2 pneumoperitoneum.The Cp50 and 95% confidence interval(CI)of remifentanil required to inhibit cardiovascular response to CO2 pneumoperitoneum stimulus when combined with propofol in patients undergoing laparoscopic gynaecological surgery were calculated.Results The Cp50(95% CI)of remifentanil required to inhibit cardiovascular response to CO2 pneumoperitoneum stimulus was 4.58(4.14-5.08)ng/ml when combined with propofol in patients undergoing laparoscopic gynaecological surgery.Conclusion The Cp50 of remifentanil required to inhibit cardiovascular response to CO2 pneumoperitoneum stimulus was 4.58 ng/ml when combined with propofol in patients undergoing laparoscopic gynaecological surgery.

引文

[1]钟涛,杨勇,朱茂恩,等.瑞芬太尼对丙泊酚靶控输注患者意识消失及诱发脑电爆发抑制时的半数有效浓度的影响.临床麻醉学杂志,2014,30(12):1165-1168.
    [2]杨成伟,陆丹军,康芳,等.复合异丙酚时瑞芬太尼抑制神经外科女性患者安置头架反应的半数有效血浆靶浓度.中华麻醉学杂志,2017,37(2):196-198.
    [3]谢阳,姜文强,谢红.复合丙泊酚时瑞芬太尼抑制光棒插管反应的半数有效效应室浓度.临床麻醉学杂志,2017,33(6):607-608.
    [4]胡云霞,曾思,兰志勋.舒芬太尼抑制双腔气管插管心血管反应的半数有效效应室浓度.临床麻醉学杂志,2015,31(4):365-367.
    [5]田雪,孟园园,安海燕,等.全麻复合肌间沟臂丛神经阻滞镇痛时罗哌卡因的半数有效浓度.临床麻醉学杂志,2018,34(1):16-20.
    [6]刘芳,徐志鹏,岳云,等.靶控输注异丙酚意识消失时血浆和效应室靶浓度的EC50与脑电双频谱指数的关系多中心大样本临床研究.中华麻醉学杂志,2007,27(4):324-327.
    [7]张熙哲,吴新民.异丙酚靶控输注时瑞芬太尼抑制气管插管反应的半数有效血浆浓度.中华麻醉学杂志,2006,26(3):204-206.
    [8]陈勇,梁敏,欧阳碧山,等.异丙酚麻醉下瑞芬太尼抑制病人气管插管和切皮时心血管反应的效应室靶浓度.中华麻醉学杂志,2007,27(1):28-31.
    [9]Zou ZY,Zhao YL,Yang XL,et al.Effects of different remifentanil target concentrations on MAC BAR of sevoflurane in gynaecological patients with CO2pneumoperitoneum stimulus.British Journal of Anaesthesia,2014,114(4):634-639.
    [10]张旭彤,李快春,徐旭仲,等.妇科腹腔镜手术患者不同靶浓度异丙酚对瑞芬太尼半数麻醉效应靶浓度的影响.中华麻醉学杂志,2008,28(5):478-479.
    [11]Choi EM,Park WK,Choi SH,et al.Smooth emergence in men undergoing nasal surgery:the effect site concentration of remifentanil for preventing cough after sevoflurane-balanced anaesthesia.Acta Anaesthesiol Scand,2012,56(4):498-503.