长期过量饮酒对舒芬太尼抑制气管插管时心血管反应ED50的影响

发布时间：2018-02-26 17:35

本文关键词： 长期过量饮酒舒芬太尼剂量效应关系气管插管　出处：《福建医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：拟通过测定长期过量饮酒对舒芬太尼抑制气管插管时心血管反应ED50的影响，从而评价长期过量饮酒对舒芬太尼效力的影响。方法:择期拟行全麻手术的成年男性患者，BMI18~25kg/m2,年龄25~55岁，ASA分级Ⅰ~Ⅱ级纳入本研究。根据世界卫生组织(WHO)对长期过量饮酒的定义将手术患者分为长期过量饮酒组（D组，n=19）和非饮酒组（N组，，n=22）。D组和N组分别先静脉注射丙泊酚2.0~3.0mg/kg(45s),维持脑状态指数(CSI)值40~55,继而静脉注射顺阿曲库铵0.2mg/kg，按预设剂量静注舒芬太尼,5min后行气管插管。监测麻醉诱导前(T0基础值)，插管前即刻(T1)，插管后1min(T2)，插管后5min(T3)血压心率和CSI的变化。按改良序贯法，舒芬太尼的第一个剂量是预实验中出现阴性反应的剂量，D组和N组初始舒芬太尼剂量分别为0.5ug/kg和0.4ug/kg，若患者反应为阳性（气管插管后MAP或HR超过基础值的15％），则下一例舒芬太尼剂量上调0.1ug/kg，若患者反应为阴性（气管插管后MAP或HR未超过基础值的15％），则下一例舒芬太尼剂量下调0.1ug/kg，重复此过程直至出现6次阴性－阳性转折停止研究。采用序贯法计算舒芬太尼ED50及其95％可信区间CI。结果：D组和N组在年龄、体重指数、性别构成均无统计学差异（P0.05），两组麻醉诱导前心率、收缩压、舒张压、CSI亦无显著性差异。D组纳入患者均为长期过量饮酒者，均未发现有酒精性疾病及其合并症。D组及N组舒芬太尼抑制气管插管时心血管反应的ED50及其95％可信区间分别为0.41(0.37，0.47)ug/kg和0.30(0.27，0.34)ug/kg，D组ED50高于N组(P0.05)。结论：长期过量饮酒可增加气管插管时舒芬太尼抑制心血管反应ED50，提示长期过量饮酒降低舒芬太尼抑制应激反应的效力。
[Abstract]:Aim: to evaluate the effect of long-term excessive drinking on the efficacy of sufentanil by measuring the effect of sufentanil on cardiovascular response (ED50) to tracheal intubation. Methods: adult male patients undergoing elective general anesthesia were divided into long-term excessive drinking group according to the World Health Organization (WHO) definition of long-term excessive drinking. Group D and group N were given intravenous injection of propofol 2.0 mg / kg / kg for 45sd respectively, and then intravenous injection of atracurium 0.2 mg / kg / kg for 5 min. The anesthesia was monitored by endotracheal intubation after 5 minutes of intravenous injection of sufentanil (0.2mg 路kg ~ (-1)) in group D (n = 10) and non-drinking group (n = 10), and then administered intravenously by intravenous injection of sufentanil (0.2mg / kg) to monitor anesthesia after 5 minutes of intravenous injection of propofol (2.0 mg / kg 路kg ~ (-1)). The changes of blood pressure and heart rate and CSI were observed immediately before intubation, 1 min after intubation, 5 min after intubation, and 5 min after intubation. The first dose of sufentanil was the initial dose of sufentanil in group D and group N, which were negative in the pretest. If the patient was positive (MAP or HR exceeded 15% of the base value after tracheal intubation), the next one was the first dose of sufentanil in group D and group N, respectively. The dose of sufentanil was increased by 0.1ug-kg. if the patient's response was negative (MAP or HR was not more than 15% of the base value after tracheal intubation), then the next case of sufentanil was down-regulated by 0.1 ug-kg-1 / kg, and repeated this process until six negative-positive turning points stopped the study. Sequential method was used to calculate sufentanil ED50 and its 95% CI. Results there was no significant difference in age, body mass index and sex composition between group D and group N. there was no significant difference in heart rate, systolic blood pressure, diastolic blood pressure and CSI between two groups before anesthesia induction. The ED50 and 95% confidence intervals of sufentanil in group D and group N for inhibiting cardiovascular response to endotracheal intubation were 0.41 ~ 0.37 渭 r / kg and 0.30 ~ 0.27 ~ 0.34 g / kg respectively. The ED50 of group D was higher than that of group N (P 0.05). Conclusion: Long-term excessive drinking can increase the inhibitory effect of sufentanil on cardiovascular response ED50 during tracheal intubation, suggesting that long-term excessive drinking reduces the inhibitory effect of sufentanil on stress response.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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