CAJ | 학술논문

目的探讨不同效应室靶浓度瑞芬太尼对患者意识消失和伤害性刺激诱发体动反应消失时依托咪酯半数有效浓度(EC50)的影响.方法择期拟在全身麻醉下行妇科手术患者80例,ASA 分级Ⅰ或Ⅱ级,年龄18～64岁,采用随机数字表法,将患者随机分为4组(n=20):R0组不使用瑞芬太尼;R1～3组瑞芬太尼效应室靶浓度分别为1、2、3ng/ml.麻醉诱导开始时先靶控输注瑞芬太尼,达设定效应室靶浓度后,再以血浆靶浓度0.6μg/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伤害性刺激诱发体动反应消失.记录患者意识消失及对伤害性刺激诱发体动反应消失时依托咪酯的效应室靶浓度,采用Probit法计算EC50.结果随瑞芬太尼效应室靶浓度升高,患者意识消失时和伤害性刺激诱发体动反应消失时依托咪酯的EC50逐渐降低(P<0.05).结论靶控输注1、2.3 ng/ml的瑞芬太尼可呈浓度依赖性地强化依托咪酯的镇静镇痛作用.
목적 탐토불동효응실파농도서분태니대환자의식소실화상해성자격유발체동반응소실시의탁미지반수유효농도(EC50)적영향.방법 택기의재전신마취하행부과수술환자80례,ASA 분급Ⅰ혹Ⅱ급,년령18～64세,채용수궤수자표법,장환자수궤분위4조(n=20):R0조불사용서분태니;R1～3조서분태니효응실파농도분별위1、2、3ng/ml.마취유도개시시선파공수주서분태니,체설정효응실파농도후,재이혈장파농도0.6μg/ml위기점개시파공수주의탁미지,차후매분종증가의탁미지적혈장파농도0.1 μg/ml직지환자의식소실급대상해성자격유발체동반응소실.기록환자의식소실급대상해성자격유발체동반응소실시의탁미지적효응실파농도,채용Probit법계산EC50.결과 수서분태니효응실파농도승고,환자의식소실시화상해성자격유발체동반응소실시의탁미지적EC50축점강저(P<0.05).결론 파공수주1、2.3 ng/ml적서분태니가정농도의뢰성지강화의탁미지적진정진통작용.
Objective To investigate the effect of different target effect-site concentrations (Ces) ofremifentanil on the median effective concentration (EC50 ) of etomidate required for loss of consciousness and disappearance of nociceptive stimuli-induced body movement. Methods Eighty ASA Ⅰ orⅡ patients aged 18-64 yr scheduled for elective gynecological surgery under general anesthesia were randomly divided into 4 groups ( n = 20 each): group R0 received no remifentanil and R1-3 groups received remifentanil at 3 predetermined target Ces of 1,2 and 3 ng/ml respectively. At the beginning of anesthesia induction, remifentanil was given by target-controlled infusion (TCI) until the predetermined Ces were achieved, TCI of etomidate was then started at a target plasma concentration of 0.6 μg/ml and then the target plasma concentration of etomidate increased by 0.1 μg/ml every 1 min until the patients lost consciousness and the body movement induced by the nociceptive stimuli disappeared. The Ce of etomidate required for loss of consciousness and disappearance of nociceptive stimuli-induced body move-ment was recorded and the EC50 was calculated by Probit method. Results With the increase in the target Ces of remifentanil, the EC50 of etomidate required for loss of consciousness and disappearance of nociceptive stimuli-induced body movement decreased gradually (P < 0.05) .Conclusion Remifentanil given by TCI can enhance the sedative and analgesic effect of etomidate concentration-dependently.