复合丙泊酚时瑞芬太尼抑制产妇气管插管反应的有效剂量

发布时间：2018-05-14 18:14

本文选题：瑞芬太尼 + 丙泊酚　；参考：《现代妇产科进展》2015年06期

【摘要】：目的:研究复合丙泊酚时瑞芬太尼抑制剖宫产产妇气管插管应激反应的有效剂量。方法:选取ASA分级1~2级、有椎管内麻醉禁忌证的32例足月产妇,患者均以理想体重为给药参数。全麻诱导给予丙泊酚持续静脉泵入,当镇静/警觉评分≤3分时,持续输注瑞芬太尼,初始剂量0.8μg/kg。调节丙泊酚给药速度,意识指数(IOC)值70开始气管插管。按改良序贯法进行试验,如发生插管反应,下一例患者瑞芬太尼升高1个给药剂量,否则降低1个给药剂量。记录新生儿出生后第1、5min Apgar评分。全麻完全苏醒后及术后第1、5天对患者进行改良的Brice问卷调查,以判断有无术中知晓。Probit回归分析瑞芬太尼的半数有效量(ED50)及95%有效量(ED95)。结果:瑞芬太尼的ED50及ED95分别为1.04μg/kg(95%CI 0.89~1.1)、1.25μg/kg(1.14~2.76)。2例(2/32)新生儿出生后1min Apgar8,需加压面罩辅助通气。患者均未出现术中知晓。结论:瑞芬太尼抑制全麻剖宫产患者气管插管反应的ED50、ED95分别为1.04μg/kg和1.25μg/kg。适当的麻醉深度可减轻瑞芬太尼对新生儿的呼吸抑制。
[Abstract]:Aim: to study the effective dose of remifentanil combined with propofol on the stress response of tracheal intubation in cesarean section women. Methods: 32 term puerperas with ASA grade 1 and 2 and contraindication of intraspinal anesthesia were selected. The patients were treated with ideal body weight. The intravenous infusion of propofol was induced by general anesthesia. Remifentanil was continuously infused with remifentanil at an initial dose of 0.8 渭 g / kg when sedation / alertness score was less than 3 points. Adjusting the rate of propofol administration, the consciousness index (IOC) of 70 began tracheal intubation. If intubation reaction occurs, remifentanil in the next patient will be increased by 1 dose or reduced by 1 dose. The Apgar score was recorded at 1 minute after birth. A modified Brice questionnaire survey was conducted on patients after general anesthesia and 5 days after operation to determine whether there was an intraoperative awareness. Probit regression analysis was conducted to determine the median effective dose of remifentanil ED50 and 95% effective dose. Results: the ED50 and ED95 of remifentanil were 1.04 渭 g/kg(95%CI 0.891.1and 1.25 渭 g/kg(1.14~2.76).2 / 2 / 32 respectively. After birth, 1min Apgar8 of remifentanil was required to be ventilated by pressure mask. None of the patients had intraoperative knowledge. Conclusion: the ED50 ED95 of remifentanil was 1.04 渭 g/kg and 1.25 渭 g / KG respectively. Appropriate anesthetic depth can reduce the respiratory inhibition of remifentanil to the newborn.
【作者单位】：山东大学齐鲁医院麻醉科;
【基金】：山东省自然科学基金资助(No:ZR2010HM120)
【分类号】：R614.2

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