芬太尼抑制老年患者胸科手术全麻苏醒期躁动的半数有效剂量张杰杰宋.docVIP

芬太尼抑制老年患者胸科手术全麻苏醒期躁动的半数有效剂量 张杰杰 宋杰 王建(南通市第一人民医院麻醉科 江苏南通 226001) 【摘要】 目的 探讨芬太尼抑制老年患者胸科手术全麻苏醒期躁动的半数有效剂量。方法 选择拟在全麻下行食道癌或肺癌等胸科手术老年患者，年龄65~77岁，体重48~82kg，ASA I或II级。麻醉诱导：咪达唑仑0.05mg/kg，依托咪酯0.3mg/kg，芬太尼4μg/kg，苯磺顺阿曲库铵0.15mg/kg。5min内完成双腔支气管内插管并行机械通气，维持PetCO2 35~45 mmHg。随后于手术切皮前再次静脉注射芬太尼，再次静脉注射芬太尼的剂量采用改良序贯法确定，并且术中不再追加除瑞芬太尼以外的任何其他镇痛药物。本研究所计算的芬太尼剂量为两次静脉注射芬太尼剂量的总和。麻醉维持：持续泵入瑞芬太尼0.1μg·kg-1·min-1，丙泊酚2~4mg·kg-1·h-1，苯磺顺阿曲库铵0.2 mg·kg-1·h-1。手术结束前30min停用苯磺顺阿曲库铵，手术结束时停用瑞芬太尼和丙泊酚。术后测定患者计躁动评分（RS），以RS评分≥2为出现麻醉苏醒期躁动。计算芬太尼抑制老年患者胸科手术全麻苏醒期躁动的半数有效剂量ED50及其95%可信区间。 结果 芬太尼抑制老年患者胸科手术全麻苏醒期躁动的半数有效剂量ED50及其95%可信区间分别为7.65μg/kg和7.36~7.84μg/kg。 【关键词】 芬太尼；抑制；躁动；胸科手术；半数有效剂量 ED50 of fentanyl on emergence agitation during recovery period in elderly patients undergoing thoracic surgery under general anesthesia. Zhang Jie-jie, Song Jie, Wang Jiang (Department of Anesthesiology, The First People’s Hospital of Nantong, Nantong 226001, China) [Abstract] Objective To explore the median effective dose (ED50) and 95% confidence interval (CI) of fentanyl on emergence agitation durin张杰杰（1982-），女，住院医师，硕士，主要研究围术期疼痛的预防与治疗 移动电话Email： HYPERLINK mailto:zjj760121@163.com zjj760121@163.comg recovery period in elderly patients undergoing thoracic surgery under general anesthesia. Methods Twenty-nine ASA I or II patients aged 65-77 years weighing 48-82 kg undergoing thoracic surgery under remifentanyl intravenous combined anesthesia were studied. The patients were unpremedicated. Anesthesia was induced with iv midazolam Lun 0.05mg/kg, etomidate 0.3mg/kg, fentanyl 4μg/kg and cisatracurium besilate 0.15mg/kg. The patients were mechanical ventilated after tracheal intubation within 5 min. The patients would be one-lung ventilated discontinuously during surgeries. Then the fentanyl was injected again before cutting. The dose of fentanyl injected the second time was determined by using modified Dixon’s up-and-down method (increment or decrement of 0.5μg/kg ). Anesthesia was maintained with remifentanyl infusion at 0.1μg·kg