靶控输注瑞芬太尼用于老年患者全麻苏醒期平稳拔管的半数有效剂量

发布时间：2018-02-08 13:40

本文关键词： 阿片类镇痛药瑞芬太尼老年患者剂量并发症气管拔管　出处：《重庆医科大学学报》2015年03期 　论文类型：期刊论文

【摘要】：目的:确定靶控输注瑞芬太尼用于老年患者全凭静脉麻醉(total intravenous aneasthesia,TIVA)后苏醒期安全平稳拔管的半数有效剂量。方法:择期全麻下行颌骨囊肿手术的老年女性患者24例,ASAⅠ~Ⅱ级,采用Dixon序贯法进行试验,开始缝合伤口时第1例患者以效应室靶浓度1 ng/ml输注瑞芬太尼,若拔管不平稳,则下一位预设靶浓度增加0.5 ng/ml。若拔管平稳,下一位预设靶浓度减少0.5 ng/ml。通过Dixon法计算瑞芬太尼用于平稳拔管的半数有效剂量(median effective concentration,EC50),利用logistic回归模型进行概率单位转换,分析瑞芬太尼EC50及其95%可信区间。比较平稳拔管组与不平稳拔管组平均动脉压和心率。结果:采用Dixon序贯法算出瑞芬太尼用于老年患者术后平稳拔管的EC50 0.94 ng/ml,概率单位换算法计算EC500.99 ng/ml(95%CI=0.52~1.51 ng/ml)。拔管期间,平稳拔管组平均动脉压、心率明显低于不平稳拔管组(P0.05)。结论:靶控输注0.94 ng/ml瑞芬太尼可以减少50%的老年患者拔管相关的咳嗽反应,抑制苏醒期心血管反应,不导致全麻苏醒延迟,确保了苏醒期的平稳拔管。
[Abstract]:Objective: to determine the target controlled infusion of remifentanil for total intravenous anesthesia (total intravenous, Aneasthesia, TIVA) median effective dose recovery period after safe extubation. Methods: 24 elderly female patients undergoing elective jaw cyst surgery were ASA grade I-II, were tested using Dixon sequential start suture the wound of first patients with 1 ng/ml target effect site concentration of remifentanil, if extubation is not stable, is under a preset target concentration increased to 0.5 ng/ml. if extubation smoothly, a preset target to reduce the concentration of 0.5 ng/ml. Dixon method was used to calculate the median effective dose of remifentanil for smooth extubation (median effective concentration. EC50), using logistic regression model for the probability of conversion, analysis of remifentanil EC50 and 95% confidence interval. Smooth extubation group and unstable extubation group mean arterial pressure and heart rate. Results: using Dixon sequential method is calculated with remifentanil in elderly patients with postoperative extubation period of 0.94 EC50 ng/ml, EC500.99 ng/ml computing unit conversion probability method (95%CI=0.52~1.51 ng/ml). During extubation, smooth extubation group mean arterial pressure, heart rate was significantly lower than the unstable extubation group (P0.05). Conclusion: the cough response related drawing elderly patients with target controlled infusion of remifentanil 0.94 ng/ml can reduce 50% of the tube, inhibit the cardiovascular response recovery period of general anesthesia, does not lead to delay, to ensure the smooth recovery period pull tube.

【作者单位】：重庆医科大学附属口腔医院麻醉科;重庆医科大学附属口腔医院颌面外科;
【分类号】：R614.2

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