CAJ | 학술논문

目的探讨复合异丙酚麻醉时舒芬太尼抑制强直电刺激和切皮诱发胸腹部手术患者体动反应的药效学.方法择期胸腹部手术患者50例,年龄18～57岁,ASA分级Ⅰ或Ⅱ级,体重为标准体重的80%～120%,随机分为5组(n=10):舒芬太尼效应室靶浓度0.07、0.10、0.14、0.20和0.28 ng/ml组.靶控输注异丙酚,血浆靶浓度3.0～3.2 μg/ml,患者意识消失时各组按设定的效应室靶浓度靶控输注舒芬太尼,待效应室和血浆浓度达平衡后,给予强直电刺激(频率50 Hz,强度80 mA,波宽0.25ms),观察患者反应后给肌松药,行气管插管,维持上述异丙酚和舒芬太尼的靶浓度到切皮后4 min,试验观察结束.观察强直电刺激和切皮时患者的体动反应情况.采用通过概率单位回归分析法计算舒芬太尼抑制电刺激和切皮诱发的体动反应的半数有效效应室靶浓度(EC50)和EC95及其95%可信区间.结果复合异丙酚麻醉时舒芬太尼抑制强直电刺激诱发的体动发应的EC50和EC95及其95%可信区间分别为0.12(0.09～0.14)ng/ml和0.20(0.17～0.31)ng/ml,抑制切皮诱发的体动发应的EC50和EC95分别为0.13(0.11～0.16)ng/ml和0.21(0.17～0.29)ng/ml;复合异丙酚麻醉时舒芬太尼抑制强直电刺激和切皮诱发的体动发应的EC50和EC95的比较差异无统计学意义(P＞0.05).结论复合异丙酚麻醉时舒芬太尼抑制强直电刺激(频率50 Hz,强度80 mA,波宽0.25 ms)诱发的体动发应的EC50和EC95分别为0.12和0.20 ng/ml,抑制切皮诱发的体动发应的EC50和EC95分别为0.13和0.21 ng/ml,且抑制两组刺激诱发的体动发应的药效学无差异,提示强直电刺激可替代切皮用于评价麻醉药的药效学.
목적 탐토복합이병분마취시서분태니억제강직전자격화절피유발흉복부수술환자체동반응적약효학.방법 택기흉복부수술환자50례,년령18～57세,ASA분급Ⅰ혹Ⅱ급,체중위표준체중적80%～120%,수궤분위5조(n=10):서분태니효응실파농도0.07、0.10、0.14、0.20화0.28 ng/ml조.파공수주이병분,혈장파농도3.0～3.2 μg/ml,환자의식소실시각조안설정적효응실파농도파공수주서분태니,대효응실화혈장농도체평형후,급여강직전자격(빈솔50 Hz,강도80 mA,파관0.25ms),관찰환자반응후급기송약,행기관삽관,유지상술이병분화서분태니적파농도도절피후4 min,시험관찰결속.관찰강직전자격화절피시환자적체동반응정황.채용통과개솔단위회귀분석법계산서분태니억제전자격화절피유발적체동반응적반수유효효응실파농도(EC50)화EC95급기95%가신구간.결과 복합이병분마취시서분태니억제강직전자격유발적체동발응적EC50화EC95급기95%가신구간분별위0.12(0.09～0.14)ng/ml화0.20(0.17～0.31)ng/ml,억제절피유발적체동발응적EC50화EC95분별위0.13(0.11～0.16)ng/ml화0.21(0.17～0.29)ng/ml;복합이병분마취시서분태니억제강직전자격화절피유발적체동발응적EC50화EC95적비교차이무통계학의의(P＞0.05).결론 복합이병분마취시서분태니억제강직전자격(빈솔50 Hz,강도80 mA,파관0.25 ms)유발적체동발응적EC50화EC95분별위0.12화0.20 ng/ml,억제절피유발적체동발응적EC50화EC95분별위0.13화0.21 ng/ml,차억제량조자격유발적체동발응적약효학무차이,제시강직전자격가체대절피용우평개마취약적약효학.
Objective To investigate the pharmacodynamics of sufentanil required to inhibit the body movement induced by tetanic stimulation and skin incision when combined with propofol in patients undergoing thoracic or abdominal surgery. Methods Fifty ASA Ⅰ or Ⅱ patients aged 18-57 yr undergoing elective thoracic or abdominal surgery were randomized into 5 groups sufentanil target effect-site concentration (Ce) (n = 10 each):0.07, 0.10, 0.14, 0.20 and 0.28 ng/ml groups. Anesthesia was induced with TCI of propofol at the target plasma concentration of 3.0-3.2 μg/ml. As soon as the patients lost consciousness, infusion of sufentanil with the corresponding Ce was started in the each group. One tetanic stimulus (frequency 50 Hz, intensity 80 mA, wave length 0.25 ms) was given after the target effect-site and plasma concentrations were balanced. Tracheal intubation was facilitated with succinylcholine 1.5 mg/kg. The concentrations of propofol and sufentanil were maintained until 4 min after skin incision. The body movement was observed during tetanic stimulation and skin incision. The effective effect-site concentration (EC50, EC94) of sufentanil and 95% confidence interval (CI) were calculated using probit regression analysis. Results The EC50 and EC95 of sufentanil required to inhibit the body movement induced by tetanic stimulation when combined with propofol were 0.12 (95% CI 0.09-0.14) ng/ml and 0.20 (95% CI 0.17-0.31) ng/ml respectively. The EC50 and EC95 of sufentanil required to inhibit the body movement induced by skin incision when combined with propofol were 0.13 (95% CI 0.11-0.16) ng/ml and 0.21 (95% CI 0.17-0.29) ng/ml respectively. There was no significant difference in the EC50 and EC95 of sufentanil between the two different stimuli (P ＞ 0.05). Conclusion The EC50 and EC95 of sufentanil required to inhibit the body movement induced by tetanic stimulation (frequency 50 Hz, intensity 80 mA, wave length 0.25 ms) when combined with propofol were 0.12 and 0.20 ng/ml respectively, the EC50 and EC95 of sufentanil required to inhibit the body movement induced by skin incision when combined with propofol were 0.13 and 0.21 ng/ml respectively and there was no significant difference in the pharmacodynamics between the two different stimuli, indicating that tetanic stimulation as an alternative to skin incision can be used to evaluate the pharmacodynamics of anesthetics.