瑞芬太尼量效关系及封顶效应的研究.docVIP

PAGE PAGE 1 瑞芬太尼量效关系及封顶效应的研究 李艳 王保国 中国医学科学院首都医科大学附属北京天坛医院麻醉和疼痛治疗科 北京市100050 责任作者：王保国；E-mail: HYPERLINK mailto:wbgttyy@ wbgttyy@ ［摘要］　目的 采用TCI技术获得稳定的瑞芬太尼效应室浓度，通过电刺激－循环反应的变化，反映瑞芬太尼的药效，从而探讨瑞芬太尼的量效关系和瑞芬太尼到达封顶效应时的剂量，为临床合理应用瑞芬太尼提供科学依据。方法 选择15例ASA Ⅰ或Ⅱ级择期额颞部开颅手术患者，先行TCI输注丙泊酚，设定效应室靶浓度为3μg?ml-1，必要时面罩辅助通气，维持患者呼气末二氧化碳浓度为35～45mmHg，待达到丙泊酚靶浓度后开始TCI输注瑞芬太尼，设定效应室靶浓度分别为2ng?ml-1、3ng?ml-1、4ng?ml-1、5ng?ml-1、6ng?ml-1、7ng?ml-1、8ng?ml-1，分别于瑞芬太尼达不同效应室浓度时给予50mA、 50Hz、5s及80mA、 50Hz、5s强直电刺激，记录电刺激前后血压、心率及BIS的变化。结果 随着瑞芬太尼效应室浓度的增加，血压及心率逐渐降低，强直电刺激后血压及心率升高幅度也逐渐降低。瑞芬太尼效应室浓度达(5.13±0.92)ng?ml-1时,50mA强直电刺激后MAP升高幅度＜5%，95%置信区间为(3.33~6.93) ng?ml-1; 瑞芬太尼效应室浓度达(6.33±1.05) ng?ml-1时,80mA强直电刺激后MAP升高幅度＜5%，95%置信区间为(4.27~8.39) ng?ml-1。随着瑞芬太尼的效应室浓度逐渐增加，BIS逐渐降低，电刺激前后BIS无明显变化。结论 随瑞芬太尼效应室浓度的增加，镇痛强度逐渐增强，电刺激－循环反应逐渐减弱；瑞芬太尼效应室浓度大于(5.13±0.92) ng?ml-1时, 95%置信区间为(3.33~6.93) ng?ml-1，50mA强直电刺激－循环反应变化不再明显，达到封顶效应; 当刺激强度增加到80mA时，瑞芬太尼量效关系曲线右移，达封顶效应的效应室浓度为(6.33±1.05) ng?ml-1，95%置信区间为(4.27~8.39) ng?ml-1。 ［关键词］瑞芬太尼；丙泊酚；麻醉；封顶效应；电刺激  The Dose-Effect and Ceiling Effect of Remifentanil LI Yan, WANG Bao-guo. Department of Anesthesiology and Pain Management, Beijing Tiantan Hospital, Capital University of Medical Sciences, Chinese Academy of Medical Sciences, Beijing 100050, China ［Abstract］　Objective To evaluate the dose-effect and ceiling effect of remifentanil by electrical stimulation-circulation response. Methods Fifteen ASA physical statusⅠorⅡpatients, scheduled for intracranial surgery, were involved in this study. Anesthesia was provided with propofol and remifentanil using a target-controlled infusion devices. Constant effect-site concentrations of 3μg?ml-1 propofol were maintained. Ventilation were assisted by mask to maintain the PETCO2 between 35～45mmHg when necessary. Constant effect-site concentrations of 2ng?ml-1,3 ng?ml-1, 4ng?ml-1, 5ng?ml-1, 6ng?ml-1, 7ng?ml-1, 8 ng?ml-1 and remifentanil were administered stepwise. Heart rate, invasive arterial pressure and BIS were monitored and recorded before and after the e