CAJ | 학술논문

目的评价七氟醚和依托咪酯镇静催眠效应的相互作用.方法择期全麻手术患者24例,ASA Ⅰ或Ⅱ级,年龄18～59岁,体重指数17～27 kg/m2.试验Ⅰ 12例患者靶控输注依托咪酯,效应室靶浓度依次为0.05、0.1、0.2、0.3、0.4、0.5 μg/ml.效应室浓度依次达到预设浓度2 min时,记录反应熵(RE)、状态熵(SE)和警觉/镇静(OAA/S)评分,然后停止输注依托咪酯.随机分为3组(n=4),A1组、B1组、C1组吸入七氟醚,呼气末浓度分别为0.5%、1%、2%.七氟醚呼气末浓度达预定浓度的95%或以上时,靶控输注依托咪酯,效应室靶浓度依次为0.2、0.3、0.4、0.5 μg/ml.效应室浓度依次达到预设浓度2 min时,记录RE、SE和OAA/S评分.试验Ⅱ 12例患者吸入七氟醚,呼气末浓度依次为0.5%、1%、2%、3%、4%、5%.依次达到预定呼气末浓度时,记录RE、SE和OAA/S评分,然后停止吸人七氟醚,吸氧洗脱七氟醚.随机分为3组(n=4),A2组、B2组、C2组靶控输注依托咪酯,效应室靶浓度分别为0.05、0.1、0.2 μg/ml.效应室浓度达到预设浓度2 min时,吸入七氟醚,呼气末浓度依次为0.5%、1%、2%、3%、4%、5%.依次达到预定呼气末浓度时,记录RE、SE和OAA/S评分.采用反应曲面法评价RE、SE和OAA/S评分,判断七氟醚和依托咪酯镇静催眠效应的相互作用.结果 RE和SE的相互作用指数的拟合值及其95%可信区间分别为0.32(-0.07～0.71)、0.25(-0.12～0.63)(P>0.05).OAA/S评分的相互作用指数的拟合值及其95%可信区间为2.25(0.58～3.93)(P<0.05).结论以脑电熵指数反映镇静催眠效应时七氟醚和依托咪酯为相加作用;以OAA/S评分反映镇静催眠效应时七氟醚和依托咪酯为协同作用.
목적 평개칠불미화의탁미지진정최면효응적상호작용.방법 택기전마수술환자24례,ASA Ⅰ혹Ⅱ급,년령18～59세,체중지수17～27 kg/m2.시험Ⅰ 12례환자파공수주의탁미지,효응실파농도의차위0.05、0.1、0.2、0.3、0.4、0.5 μg/ml.효응실농도의차체도예설농도2 min시,기록반응적(RE)、상태적(SE)화경각/진정(OAA/S)평분,연후정지수주의탁미지.수궤분위3조(n=4),A1조、B1조、C1조흡입칠불미,호기말농도분별위0.5%、1%、2%.칠불미호기말농도체예정농도적95%혹이상시,파공수주의탁미지,효응실파농도의차위0.2、0.3、0.4、0.5 μg/ml.효응실농도의차체도예설농도2 min시,기록RE、SE화OAA/S평분.시험Ⅱ 12례환자흡입칠불미,호기말농도의차위0.5%、1%、2%、3%、4%、5%.의차체도예정호기말농도시,기록RE、SE화OAA/S평분,연후정지흡인칠불미,흡양세탈칠불미.수궤분위3조(n=4),A2조、B2조、C2조파공수주의탁미지,효응실파농도분별위0.05、0.1、0.2 μg/ml.효응실농도체도예설농도2 min시,흡입칠불미,호기말농도의차위0.5%、1%、2%、3%、4%、5%.의차체도예정호기말농도시,기록RE、SE화OAA/S평분.채용반응곡면법평개RE、SE화OAA/S평분,판단칠불미화의탁미지진정최면효응적상호작용.결과 RE화SE적상호작용지수적의합치급기95%가신구간분별위0.32(-0.07～0.71)、0.25(-0.12～0.63)(P>0.05).OAA/S평분적상호작용지수적의합치급기95%가신구간위2.25(0.58～3.93)(P<0.05).결론 이뇌전적지수반영진정최면효응시칠불미화의탁미지위상가작용;이OAA/S평분반영진정최면효응시칠불미화의탁미지위협동작용.
Objective To evaluate sedative and hypnotic interactions between sevoflurane and etomidate. Methods Twenty-four ASA Ⅰ or Ⅱ patients aged 18-59 yr with body mass index 17-27 kg/m2 undergoing elective surgery under general anesthesia were included in this study. Part Ⅰ Twelve patients received etemidate by TCI at target effect-site concentrations (Ce) of 0.05, 0.1, 0.2, 0.3, 0.4 and 0.5 μg/ml in turn. When the preset concentrations were reached for 2 min, the spectral entropy index (response entropy, RE; state entropy, SE) and Observer's Assessment of Alertuess/Sedation (OAA/S) score were recorded and TCI of etomidate was stopped. The patients were randomly divided into 3 groups ( n = 4 each), inhaling sevoflurane with end-tidal concentrations of 0.5% (group A1 ), 1% (group B1 ) and 2% (group C1 ). When the sevoflurane concentration reached 95% predetermined end-tidal concentration or more, etomidate was administered via TCI at Ce of 0.05, 0.1, 0.2, 0.3, 0.4 and 0.5 μg/ml in turn. When the preset concentrations were reached for 2 min, RE, SE and OAA/S score were recorded. Part Ⅱ Twelve patients inhaled sevoflurane with end-tidal concentrations of 0.5%, 1%, 2%, 3%, 4% and 5% in turn. When the predetermined end-tidal concentrations were reached, RE, SE and OAA/S score were recorded and inhalation of sevoflurane was stopped. Sevoflurane was washed out. Then the patients were randomly divided into 3 groups ( n = 4 each), receiving etomidate by TCI at Ce of 0.05 μg/ml (group A2), 0.1 μg/ml ( group B2) and 0.2 μg/ml ( group C2) respectively. The patients inhaled sevoflurane with end-tidal concentrations of 0.5%, 1%, 2%, 3%, 4% and 5% in turn 2 min after the preset concentrations were reached. When the predetermined end-tidal concentrations were reached, RE, SE and OAA/S score were recorded. Response surface pharmacodynamic interaction models were constructed to evaluate RE, SE and OAA/S score and determine sedative and hypnotic interactions between sevoflurane and etomidate. Results The fitted values of the interaction index a of RE and SE (95% confidence intervals, 95% CI) were 0.32 ( - 0.07-0.71 ) and 0.25 (-0.12-0.63) respectively (P > 0.05). The fitted value of the interaction index a of OAA/S score (95% CI) was 2.25 (0.58-3.93) (P <0.05).Conclusion The interaction between etomidate and sevoflurane is additive and synergistic for sedation and hypnosis assessed by spectral entropy index and by OAA/S score respectively.