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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:

33卷

期数:

2020年15期

页码:

103-105

栏目:

临床研究

出版日期:

2020-08-01

文章信息/Info

Title:

The Effect of Plasma Concentration of Remifentanil on the Anesthetic Efficacy of Etomidate

文章编号:

1006-1959（2020）15-0103-03

作者:

谭彬彬; 陈 君

天津市环湖医院麻醉科，天津 300060

Author(s):

TAN Bin-bin; CHEN Jun

Department of Anesthesiology,Tianjin Huanhu Hospital,Tianjin 300060,China

关键词:

依托咪酯;  瑞芬太尼;  靶控输注

Keywords:

Etomidate; Remifentanil; Target-controlled infusion

分类号:

R614.2

DOI:

10.3969/j.issn.1006-1959.2020.15.031

文献标志码:

A

摘要:

目的 研究靶控输注不同血浆浓度瑞芬太尼对依托咪酯麻醉效能的影响。方法 选择2018年12月~2019年10月我院拟于全凭静脉麻醉下行颈内动脉内膜剥脱术患者80例作为研究对象，按照随机数字表法将其分为R0、R1、R2、R3四组，R0组不使用瑞芬太尼，R1、R2、R3诱导开始时先靶控输注瑞芬太尼至血浆靶浓度为1、2、3 ng/ml，再以血浆浓度0.5 μg/ml为起点开始靶控输注依托咪酯，此后每分钟增加依托咪酯的血浆靶浓度0.1 μg/ml直至患者意识消失及对电刺激体动反应消失。比较四组入室时、瑞芬太尼达靶浓度时、意识消失时和疼痛刺激反应消失时心率（HR）和平均动脉压（MAP），记录四组意识消失及对疼痛刺激体动反应消失时依托咪酯的血浆浓度及脑电双频谱指数（BIS）值，通过Probit法计算依托咪酯血浆浓度的半数有效浓度（EC50）和患者的半数入睡BIS值（BIS50）。结果 ①R1组疼痛刺激体动反应消失时的MAP和HR高于意识消失时，差异有统计学意义（P＜0.05）；意识消失时，R3组HR低于R0组，差异有统计学意义（P＜0.05）；疼痛刺激体动反应消失时，R3组MAP和HR低于R1组，差异有统计学意义（P＜0.05）。②意识消失时，R0、R1、R2、R3组依托咪酯的EC50分别为0.80 μg/ml、0.72 μg/ml、0.65 μg/ml和0.58 μg/ml，BIS50分别为47、50、45、47；疼痛刺激体动反应消失时，R1、R2、R3组依托咪酯的EC50分别为0.94 μg/ml、0.84 μg/ml和0.72 μg/ml，BIS50分别为54、49和52。结论 靶控输注1、2、3 ng/ml的瑞芬太尼可以呈剂量依赖性地降低手术患者意识消失和疼痛刺激体动反应消失时所需依托咪酯血浆浓度的EC50，提高依托咪酯的麻醉效能；另外，患者对疼痛刺激体动反应消失时的BIS50较意识消失时有所上升。

Abstract:

Objective To study the effect of target-controlled infusion of different plasma concentrations of remifentanil on the anesthetic efficacy of etomidate.Methods From December 2018 to October 2019, 80 patients with internal carotid endarterectomy under total intravenous anesthesia in our hospital were selected as the research objects, and they were divided into R0, R1, R2, R3 according to the random number table method four groups, R0 group did not use remifentanil, at the beginning of R1, R2, and R3 induction, remifentanil was first target-controlled infusion to the plasma target concentration of 1, 2, 3 ng/ml, and then the plasma concentration was 0.5 μg/ml the target-controlled infusion of etomidate was started with ml as the starting point, and the target plasma concentration of etomidate was increased by 0.1 μg/ml every minute until the patient’s consciousness disappeared and the body response to electrical stimulation disappeared. Compare the heart rate (HR) and mean arterial pressure (MAP) when the four groups enter the room, when the target concentration of remifentanil reaches the target concentration, when the consciousness disappears, and when the pain response disappears. Record the four groups when the consciousness disappears and the body movement response to the pain stimulation disappears the plasma concentration of etomidate and the bispectral index (BIS) value of etomidate were calculated by the Probit method to calculate the half effective concentration (EC50) of etomidate plasma concentration and the BIS value (BIS50) of half of patients falling asleep. Results ①The MAP and HR of the R1 group when the pain stimulus disappeared were higher than when the consciousness disappeared, the difference was statistically significant (P＜0.05); when the consciousness disappeared, the HR of the R3 group was lower than the R0 group, the difference was statistically significant (P＜0.05); when the painful stimulation disappeared, the MAP and HR of the R3 group were lower than those of the R1 group, the difference was statistically significant (P<0.05). ②When consciousness disappeared, the EC50 of etomidate in the R0, R1, R2, and R3 groups were 0.80 μg/ml, 0.72 μg/ml, 0.65 μg/ml and 0.58 μg/ml, respectively, and the BIS50 were 47, 50, 45, 47, respectively; The EC50 of etomidate in groups R1, R2, and R3 were 0.94 μg/ml, 0.84 μg/ml, and 0.72 μg/ml when the body movement response to pain stimulation disappeared, and the BIS50 was 54, 49, and 52, respectively.Conclusion Target-controlled infusion of 1 ng/ml, 2 ng/ml, and 3 ng/ml remifentanil can dose-dependently reduce etomidate plasma concentration in patients undergoing surgery with disappearance of consciousness and painful stimuli. The EC50 improves the anesthetic efficacy of etomidate; in addition, the BIS50 of the patient when the patient’s body response to painful stimulation disappears is higher than when the consciousness disappears.

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