丙泊酚复合瑞芬太尼用于经阴道取卵术麻醉的药效学

发布时间：2018-05-12 18:00

本文选题：麻醉 + 瑞芬太尼　；参考：《临床麻醉学杂志》2017年06期

【摘要】：目的评价丙泊酚复合瑞芬太尼用于经阴道取卵术麻醉的临床效果,根据给药时间、剂量和药代动力学模型,用计算机模拟药物浓度,建立并分析药效学模型及其特点。方法静脉麻醉下行经阴道取卵术患者42例,ASAⅠ或Ⅱ级,随机分为两组,分别静脉注射瑞芬太尼1.5μg/kg+丙泊酚1.5mg/kg(PR15组,n=24)或瑞芬太尼1.0μg/kg+丙泊酚1.0 mg/kg(PR10组,n=18)。根据患者体动反应和自诉疼痛情况,酌情追加瑞芬太尼0.5μg/kg和/或丙泊酚0.5 mg/kg。麻醉质量评价主要指标包括睫毛反射消失时间、定向力恢复时间、低氧发生率(SpO_292%)及其他不良反应。基于模拟浓度、非线性混合效应模型、采用NONMEM软件建立药效学模型。结果PR15组患者定向力恢复时间明显慢于PR10组[(4.9±1.3)min vs(3.6±1.2)min,P0.05];但两组睫毛反射消失时间[(58±14)s vs(64±13)s]、低氧(12.5%vs 16.7%)和咳嗽(16.7%vs11.1%)发生率差异无统计学意义。50%患者有效镇静的丙泊酚浓度和有效镇痛的瑞芬太尼浓度(EC_(50))分别是1.71μg/ml、2.57ng/ml;95%患者有效镇静的丙泊酚浓度和有效镇痛的瑞芬太尼浓度(EC_(95))分别为4.30μg/ml、4.57ng/ml。丙泊酚1.0 mg/kg产生的峰效应位浓度低于EC_(50),而1.5mg/kg产生的峰效应位则高于EC_(50);但瑞芬太尼1.0、1.5μg/kg产生的峰效应位浓度均高于EC_(50),后者接近EC_(95)。结论基于患者恢复时间,经阴道取卵术麻醉时瑞芬太尼1.0μg/kg复合丙泊酚1.0mg/kg较为合适。
[Abstract]:Objective to evaluate the clinical effect of propofol combined with remifentanil in anaesthesia of transvaginal oocyte extraction. According to the model of administration time, dose and pharmacokinetics, the pharmacodynamics model and its characteristics were established and analyzed by computer simulation of the concentration of propofol and remifentanil. Methods Forty-two patients with transvaginal oocyte extraction were randomly divided into two groups: intravenous remifentanil 1.5 渭 g/kg propofol 1.5mg/kg(PR15 group (n = 24) or remifentanil 1.0 渭 g/kg propofol group (n = 20) or remifentanil 1.0 渭 g/kg propofol group (n = 18). Remifentanil 0.5 渭 g/kg and / or propofol 0.5 mg / kg were added according to the patient's body movement and private pain. The main indexes of anaesthesia quality evaluation included the disappearance time of mascara reflex, the recovery time of directional force, the incidence of hypoxia, SpO292) and other adverse reactions. Based on the model of simulated concentration and nonlinear mixing effect, the pharmacodynamics model was established by NONMEM software. Results the recovery time of orientation in PR15 group was significantly slower than that in PR10 group [4.9 卤1.3)min vs(3.6 卤1.2 min P0.05], but there was no significant difference in the incidence of effective propofol concentration and effective propofol concentration between the two groups [58 卤14s vs(64 卤13s, 12.5% vs 16.7 vs 16.7i] and cough group (16.7vs 11.1g). The effective sedative concentration of propofol and the effective analgesic concentration of remifentanil in 95% patients were 4.30 渭 g / ml / ml and 4.57 ng / ml / ml, respectively. The peak effect site concentration of propofol 1.0 mg/kg was lower than that of mg/kg, while the peak effect level of 1.5mg/kg was higher than that of ECS, but the peak effect level of remifentanil 1.0 渭 g/kg was higher than that of ECS. Conclusion based on the recovery time, remifentanil 1.0 渭 g/kg combined with propofol 1.0mg/kg is more suitable for vaginal oocyte extraction anesthesia.
【作者单位】：新疆石河子大学医学院第一附属医院麻醉科;上海交通大学医学院附属仁济医院麻醉科;新疆生产建设兵团医院麻醉科;
【分类号】：R614

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