中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2014年
5期
590-592
,共3页
谢文钦%谢文吉%江长城%康振明%杨玉欣
謝文欽%謝文吉%江長城%康振明%楊玉訢
사문흠%사문길%강장성%강진명%양옥흔
老年人%芬太尼%剂量效应关系,药物%二异丙酚%胃镜检查
老年人%芬太尼%劑量效應關繫,藥物%二異丙酚%胃鏡檢查
노년인%분태니%제량효응관계,약물%이이병분%위경검사
Aged%Fentanyl%Dose-response relationship,drug%Propofol%Gastroscopy
目的 评价不同剂量芬太尼对异丙酚抑制高龄患者胃镜检查术诱发体动反应半数有效血浆靶浓度(EC50)的影响.方法 择期胃镜检查术高龄患者90例,性别不限,年龄75～89岁,体重指数19～25 kg/m,ASA分级Ⅱ或Ⅲ级.采用随机数字表法,将其分为3组(n=30):对照组(C组)和不同剂量芬太尼组(F05组、F10组).F0.5组、E1.0组分别静脉注射芬太尼0.5、1.0 μg/kg,C组静脉注射生理盐水5ml.靶控输注异丙酚,C组、F05组和F10组初始血浆靶浓度分别为2.0、1.5和1.0μg/ml,达到靶浓度后行胃镜检查术.胃镜检查过程中患者出现头部或四肢有目的较大动作,则定义为体动反应.采用序贯法确定异丙酚血浆靶浓度,相邻浓度差值为0.5 μ/ml,出现体动反应者,下一例采用高一级浓度,否则采用低一级浓度.用概率单位法确定异丙酚EC50及其95％可信区间(CI).结果 C组异丙酚EC50 (95％CI)为2.24(1.67 ～ 2.47) μg/ml,F0.5组异丙酚EC50 (95％ CI)为1.79(1.55～1.95) μg/ml,F1.0组异丙酚EC50 (95％CI)为1.13(1.08～ 1.62) μg/ml.与C组和F05组相比,F10组异丙酚EC50降低(P＜0.05),C组和F05组异丙酚EC50比较差异无统计学意义(P＞0.05).结论 复合异丙酚时芬太尼用于高龄患者胃镜检查术静脉麻醉的推荐剂量为1.0 μg/kg.
目的 評價不同劑量芬太尼對異丙酚抑製高齡患者胃鏡檢查術誘髮體動反應半數有效血漿靶濃度(EC50)的影響.方法 擇期胃鏡檢查術高齡患者90例,性彆不限,年齡75～89歲,體重指數19～25 kg/m,ASA分級Ⅱ或Ⅲ級.採用隨機數字錶法,將其分為3組(n=30):對照組(C組)和不同劑量芬太尼組(F05組、F10組).F0.5組、E1.0組分彆靜脈註射芬太尼0.5、1.0 μg/kg,C組靜脈註射生理鹽水5ml.靶控輸註異丙酚,C組、F05組和F10組初始血漿靶濃度分彆為2.0、1.5和1.0μg/ml,達到靶濃度後行胃鏡檢查術.胃鏡檢查過程中患者齣現頭部或四肢有目的較大動作,則定義為體動反應.採用序貫法確定異丙酚血漿靶濃度,相鄰濃度差值為0.5 μ/ml,齣現體動反應者,下一例採用高一級濃度,否則採用低一級濃度.用概率單位法確定異丙酚EC50及其95％可信區間(CI).結果 C組異丙酚EC50 (95％CI)為2.24(1.67 ～ 2.47) μg/ml,F0.5組異丙酚EC50 (95％ CI)為1.79(1.55～1.95) μg/ml,F1.0組異丙酚EC50 (95％CI)為1.13(1.08～ 1.62) μg/ml.與C組和F05組相比,F10組異丙酚EC50降低(P＜0.05),C組和F05組異丙酚EC50比較差異無統計學意義(P＞0.05).結論 複閤異丙酚時芬太尼用于高齡患者胃鏡檢查術靜脈痳醉的推薦劑量為1.0 μg/kg.
목적 평개불동제량분태니대이병분억제고령환자위경검사술유발체동반응반수유효혈장파농도(EC50)적영향.방법 택기위경검사술고령환자90례,성별불한,년령75～89세,체중지수19～25 kg/m,ASA분급Ⅱ혹Ⅲ급.채용수궤수자표법,장기분위3조(n=30):대조조(C조)화불동제량분태니조(F05조、F10조).F0.5조、E1.0조분별정맥주사분태니0.5、1.0 μg/kg,C조정맥주사생리염수5ml.파공수주이병분,C조、F05조화F10조초시혈장파농도분별위2.0、1.5화1.0μg/ml,체도파농도후행위경검사술.위경검사과정중환자출현두부혹사지유목적교대동작,칙정의위체동반응.채용서관법학정이병분혈장파농도,상린농도차치위0.5 μ/ml,출현체동반응자,하일례채용고일급농도,부칙채용저일급농도.용개솔단위법학정이병분EC50급기95％가신구간(CI).결과 C조이병분EC50 (95％CI)위2.24(1.67 ～ 2.47) μg/ml,F0.5조이병분EC50 (95％ CI)위1.79(1.55～1.95) μg/ml,F1.0조이병분EC50 (95％CI)위1.13(1.08～ 1.62) μg/ml.여C조화F05조상비,F10조이병분EC50강저(P＜0.05),C조화F05조이병분EC50비교차이무통계학의의(P＞0.05).결론 복합이병분시분태니용우고령환자위경검사술정맥마취적추천제량위1.0 μg/kg.
Objective To evaluate the effects of different doses of fentanyl on the median effective target plasma concentration (EC50) of propofol inhibiting body movement evoked by gastroscopy in the elderly patients.Methods Ninety patients of both sexes,aged 75-89 yr,with a body mass index of 19-25 kg/m2,of ASA physical status Ⅱ or Ⅲ,scheduled for elective gastroscopy,were randomly divided into 3 groups (n =30 each):control group (group C) and different doses of fentanyl groups (F0.5 and F1.0 groups).Fentanyl 0.5 and 1.0 μg/kg were injected intravenously in F0.5 and F1.0 groups,respectively.Propofol was then administered by target-controlled infusion.The initial target plasma concentrations (Cps) of propofol were 2.0,1.5 and 1.0 μg/ml in C,F0.5 and F1.0 groups,respectively.Gastroscopy was performed after the target effect-site and plasma concentrations were balanced.Body movement was defined as movement in head or four extremities during gastroscopy.The target Cp of propofol was determined by up-and-down sequential trial.Each time the Cp increased/decreased by 0.5 μg/ml in the next patient depending on whether or not body movement developed.The EC50 and 95 ％ confidence interval (CI) of propofol inhibiting gastroscopy-evoked body movement were determined using Probit analysis.Results The EC50 (95 ％ CI) of propofol was 2.24 ng/ml (1.67-2.47 ng/ml) in group C,1.79 (1.55-1.95) μg/ml in group F0.5,and 1.13 (1.08-1.62) μg/ml in group F1.0.There was no significant difference in the EC50 of propofol between F0.5 and C groups.The EC50 of propofol was significantly lower in F1.0 group than in C and F0.5 groups.Conclusion When combined with propofol,fentanyl 1.0 μg/kg is recommended for gastroscopy in the elderly patients.
