CAJ | 학술논문

目的评价不同剂量右美托咪定对七氟醚抑制患儿气管插管反应时半数有效呼气末浓度(EC5o)的影响.方法择期全麻手术患儿67例,性别不限,年龄3～8岁,体重为标准体重的150％以内,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其分为3组:对照组(C组,n=22)不输注右美托咪定;不同剂量右美托咪定组(D1组,n =23;D2组,n=22)分别于麻醉诱导前经10min静脉输注右美托咪定1.0和2.0 μg/kg,随后以0.5和1.0 μg.kg-1.h-1的速率静脉输注.麻醉诱导:吸入5％七氟醚,睫毛反射消失后,调整呼气末七氟醚浓度至目标浓度并平衡15 min,行气管插管,并行气管插管反应评分.采用序贯法进行试验,C组、D1组和D2组初始呼气末七氟醚浓度分别为3.5％、2.5％和1.5％,根据气管插管反应(气管插管反应评分＞1分为阳性反应)以1.2倍等比级增减,计算七氟醚EC50及其95％可信区间(95％CI).记录右美托咪定给药后心血管事件的发生情况.结果 D1组未发生心血管事件;D2组低血压发生率14％,心动过缓发生率9％.七氟醚EC50(95％ CI)分别为:C组3.54％(3.39％～3.69％)、D1组2.37％ (2.24％～ 2.46％)、D2组1.41％(1.37％～1.46％).与C组比较,D1组和D2组EC50降低(P＜0.01);与D1组比较,D2组EC50降低(P＜0.01).结论对于患儿,复合七氟醚麻醉诱导时右美托咪定的适宜用量为负荷量1.0μg/kg,维持量0.5 μg·kg-1 ·h-1.
목적 평개불동제량우미탁미정대칠불미억제환인기관삽관반응시반수유효호기말농도(EC5o)적영향.방법 택기전마수술환인67례,성별불한,년령3～8세,체중위표준체중적150％이내,ASA분급Ⅰ혹Ⅱ급,채용수궤수자표법,장기분위3조:대조조(C조,n=22)불수주우미탁미정;불동제량우미탁미정조(D1조,n =23;D2조,n=22)분별우마취유도전경10min정맥수주우미탁미정1.0화2.0 μg/kg,수후이0.5화1.0 μg.kg-1.h-1적속솔정맥수주.마취유도:흡입5％칠불미,첩모반사소실후,조정호기말칠불미농도지목표농도병평형15 min,행기관삽관,병행기관삽관반응평분.채용서관법진행시험,C조、D1조화D2조초시호기말칠불미농도분별위3.5％、2.5％화1.5％,근거기관삽관반응(기관삽관반응평분＞1분위양성반응)이1.2배등비급증감,계산칠불미EC50급기95％가신구간(95％CI).기록우미탁미정급약후심혈관사건적발생정황.결과 D1조미발생심혈관사건;D2조저혈압발생솔14％,심동과완발생솔9％.칠불미EC50(95％ CI)분별위:C조3.54％(3.39％～3.69％)、D1조2.37％ (2.24％～ 2.46％)、D2조1.41％(1.37％～1.46％).여C조비교,D1조화D2조EC50강저(P＜0.01);여D1조비교,D2조EC50강저(P＜0.01).결론 대우환인,복합칠불미마취유도시우미탁미정적괄의용량위부하량1.0μg/kg,유지량0.5 μg·kg-1 ·h-1.
Objective To evaluate the effects of different doses of dexmedetomidine on median effective end-tidal concentration of sevoflurane (EC50) inhibiting responses to tracheal intubation in pediatric patients.Methods Sixty-seven ASA physical status Ⅰ or Ⅱ patients,aged 3-8 yr,with body weight not exceeding 150％ of the ideal weight,scheduled for elective surgery under general anesthesia,were randomly divided into 3 groups using a random number table:control group (group C,n =22) and different doses of dexmedetomidine groups (group D1,n =23 ; group D2,n =22).Before induction of anesthesia,dexmedetomidine 1.0 and 2.0 μg/kg was infused intravenously over 10 min followed by infusion at a rate of 0.5 and 1.0 μg·kg-1 ·h-1 in D1 and D2 groups,respectively.Anesthesia was induced with inhalation of 5 ％ sevoflurane.After eyelash reflex disappeared,the end-tidal sevoflurane concentration was adjusted to achieve the target concentration and maintained at this level for 15 min.Tracheal intubation was then performed and the response to intubation was scored.The initial end-tidal sevoflurane concentration was 3.5％,2.5％ and 1.5％ in C,D1 and D2 groups,respectively.Up-and-down sequential trial was used to determine the EC50.Each time the concentration of sevoflurane increased/decreased in the next patient depending on whether or not the response to intubation was positive.The positive response to intubation was defined as intubation score ＞ 1.The ratio of concentrations between the two consecutive patients was 1.2.The EC50 and 95％ confidence interval of sevoflurane were calculated.The development of adverse cardiovascular events was recorded after dexmedetomidine administration.Results The adverse cardiovascular events were not observed in D1 group.The incidence of hypotension and brachycardia was 14％ and 9％ in D2 group.The EC50 (95％ confidence interval) of sevoflurane was 3.54％ (3.39％-3.69％),2.37％ (2.24％-2.46％) and 1.41 ％ (1.37％-1.46 ％) in C,D1 and D2 groups,respectively.Compared with group C,the EC50 of sevoflurane was significantly decreased in D1 and D2 groups (P ＜ 0.01).Compared with group D1,the EC50 of sevoflurane was significantly decreased in group D2 (P ＜ 0.01).Conclusion The optimum dose of dexmedetomidine is 1.0 μg/kg (loading dose) and 0.5 μg· kg-1 · h-1 (maintenance dose) when combined with sevoflurane for induction of anesthesia in pediatric patients.