CAJ | 학술논문

目的：确定复合异丙酚时瑞芬太尼抑制老年男性患者喉罩置入反应的半数有效效应室浓度（EC50）。方法择期全麻下拟行经尿道膀胱肿瘤或前列腺电切术男性患者30例，ASA分级Ⅰ或Ⅱ级，体重指数＜30 kg/m2，年龄＞65岁。采用靶控输注异丙酚诱导，血浆靶浓度设为3μg/ml ，当镇静/警醒评分≤1分时，靶控输注瑞芬太尼，初始靶浓度为4.0 ng/ml。调节异丙酚靶浓度，BIS值55～65时置入喉罩，按改良序贯法进行试验，发生喉罩置入反应，下一例患者升高1个浓度梯度，否则降低1个浓度梯度，相邻浓度比值为1.2。发生喉罩置入反应的标准为：置入过程中或置入后3 min内发生明显咳嗽、喉痉挛和/或体动。计算复合异丙酚时瑞芬太尼抑制老年男性患者喉罩置入反应的EC50及其95％可信区间（95％ CI ）。结果复合异丙酚时瑞芬太尼抑制老年男性患者喉罩置入反应的EC50及其95％ CI为1.86（1.64～2.12） ng/ml。结论复合异丙酚时瑞芬太尼抑制老年男性患者喉罩置入反应的EC50为1.86 ng/ml。
목적：학정복합이병분시서분태니억제노년남성환자후조치입반응적반수유효효응실농도（EC50）。방법택기전마하의행경뇨도방광종류혹전렬선전절술남성환자30례，ASA분급Ⅰ혹Ⅱ급，체중지수＜30 kg/m2，년령＞65세。채용파공수주이병분유도，혈장파농도설위3μg/ml ，당진정/경성평분≤1분시，파공수주서분태니，초시파농도위4.0 ng/ml。조절이병분파농도，BIS치55～65시치입후조，안개량서관법진행시험，발생후조치입반응，하일례환자승고1개농도제도，부칙강저1개농도제도，상린농도비치위1.2。발생후조치입반응적표준위：치입과정중혹치입후3 min내발생명현해수、후경련화/혹체동。계산복합이병분시서분태니억제노년남성환자후조치입반응적EC50급기95％가신구간（95％ CI ）。결과복합이병분시서분태니억제노년남성환자후조치입반응적EC50급기95％ CI위1.86（1.64～2.12） ng/ml。결론복합이병분시서분태니억제노년남성환자후조치입반응적EC50위1.86 ng/ml。
Objective To determine the median effective effect-site concentration (EC50 ) of remifentanil inhibiting responses to laryngeal mask airway insertion when combined with propofol in elderly male patients . Methods Thirty ASA physical status Ⅰ or Ⅱ male patients ,aged 65>yr ,with body mass index <30 kg/m2 , scheduled for elective transurethral resection of bladder tumor or prostate under general anesthesia ,were enrolled in this study .Anesthesia was induced with target-controlled infusion of propofol with a target plasma concentration (Cp) of 3 μg/ml .When Observer′s Assessment of Alertness/Sedation (OAA/S ) score ≤1 ,remifentanil target-controlled infusion was started with the initial target Cp set at 4.0 ng/ml . The concentration of propofol was adjusted until BIS value reached 55-65 ,and then the laryngeal mask airway was inserted .Modified Dixon’s up-and-down method was used to determine the Cp of remifentanil . Each time the Cp of remifentanil increased/decreased in the next patient depending on whether or not the response to laryngeal mask airway insertion occurred . The ratio of the two successive Cps was 1.2 .The response to laryngeal mask airway insertion was defined as development of coughing ,laryngospasm and/or body movement during insertion or within 3 min after insertion .The number of patients in whom inhibition of responses to insertion was effective/ineffective was recorded .The EC50 of remifentanil required to inhibit responses to laryngeal mask airway insertion and the 95% confidence interval when combined with propofol were calculated .Results The EC50 (95% confidence interval ) of remifentanil required to inhibit responses to laryngeal mask airway insertion was 1.86 (1.64-2.12) ng/ml when combined with propofol in elderly male patients .Conclusion The EC50 of remifentanil required to inhibit responses to laryngeal mask airway insertion is 1.86 ng/ml when combined with propofol in elderly male patients .