CAJ | 학술논문

目的确定复合异丙酚麻醉时瑞芬太尼抑制重度子痫前期剖宫产术患者气管插管反应的量效关系.方法选取拟在全麻下行剖宫产术的重度子痫前期患者100例,年龄20～36岁,体重62～93 kg,BMI≤35 kg/m2,孕龄32 ～ 36周,ASA分级Ⅰ或Ⅱ级.采用随机数字表法分为5组(n=20):R1组-R5组.麻醉诱导:5组分别静脉注射瑞芬太尼0.25 μg/kg(R1组)、0.50 μg/kg(R2组)、0.75 μg/ kg(R3组)、1.00 μg/kg(R4组)和1.25μg/kg(R5组)、异丙酚1.5～2.0 mg/kg、琥珀胆碱1.5 mg/kg,气管插管后行机械通气.麻醉维持:胎儿娩出前吸入2％七氟醚,胎儿娩出后静脉注射咪达唑仑30 μg/kg、芬太尼6 μg/kg、顺阿曲库铵0.2 mg/kg,静脉输注异丙酚4～7 mg· kg-1·h-1、瑞芬太尼0.2 μg· kg-1·h-1.气管插管后SP≥160 mmHg、且持续时间超过1 min为气管插管反应阳性.采用probit概率单位法计算瑞芬太尼抑制气管插管反应的半数有效剂量(ED50)、95％有效剂量(ED95)及95％可信区间(CI).结果瑞芬太尼抑制重度子痫前期剖宫产术患者气管插管反应的ED50 (95％ CI)为0.65(0.53 ～ 0.77)μg/kg,ED95(95％CI)为1.30(1.10～ 1.70) μg/kg.结论复合异丙酚麻醉时,瑞芬太尼抑制重度子痫前期剖宫产术患者气管插管反应的ED50和ED95分别为0.65和1.30 μg/kg.
목적 학정복합이병분마취시서분태니억제중도자간전기부궁산술환자기관삽관반응적량효관계.방법 선취의재전마하행부궁산술적중도자간전기환자100례,년령20～36세,체중62～93 kg,BMI≤35 kg/m2,잉령32 ～ 36주,ASA분급Ⅰ혹Ⅱ급.채용수궤수자표법분위5조(n=20):R1조-R5조.마취유도:5조분별정맥주사서분태니0.25 μg/kg(R1조)、0.50 μg/kg(R2조)、0.75 μg/ kg(R3조)、1.00 μg/kg(R4조)화1.25μg/kg(R5조)、이병분1.5～2.0 mg/kg、호박담감1.5 mg/kg,기관삽관후행궤계통기.마취유지:태인면출전흡입2％칠불미,태인면출후정맥주사미체서륜30 μg/kg、분태니6 μg/kg、순아곡고안0.2 mg/kg,정맥수주이병분4～7 mg· kg-1·h-1、서분태니0.2 μg· kg-1·h-1.기관삽관후SP≥160 mmHg、차지속시간초과1 min위기관삽관반응양성.채용probit개솔단위법계산서분태니억제기관삽관반응적반수유효제량(ED50)、95％유효제량(ED95)급95％가신구간(CI).결과 서분태니억제중도자간전기부궁산술환자기관삽관반응적ED50 (95％ CI)위0.65(0.53 ～ 0.77)μg/kg,ED95(95％CI)위1.30(1.10～ 1.70) μg/kg.결론 복합이병분마취시,서분태니억제중도자간전기부궁산술환자기관삽관반응적ED50화ED95분별위0.65화1.30 μg/kg.
Objective To determine the dose-response relationship of remifentanil inhibiting responses to endotracheal intubation when combined with propofol in severely preeclamptic patients undergoing caesarean section.Methods One hundred severely preeclamptic patients,aged 20-36 yr,weighing 32-36 kg,with body mass index ≤ 35 kg/m2,at 32-36 weeks of gestation,of ASA physical status Ⅰ or Ⅱ,undergoing caesarean section under general anesthesia,were randomly divided into 5 groups (n =20 each) using a random number table:group R1-group R5.Anesthesia was induced with iv injection of remifentanil 0.25 μg/kg (group R1),0.50 μg/kg (group R2),0.75 μg/kg (group R3),1.00 μg/kg (group R4) or 1.25 μg/kg (group R5),propofol 1.5-2.0 mg/kg,and succinylcholine 1.5 mg/kg.The patients were endotracheally intubated and mechanically ventilated.Anesthesia was maintained with inhalation of 2％ sevoflurane before birth,and iv injection of midazolam 30 μg/kg,fentanyl 6 μg/kg,and cis-atracurium 0.2 mg/kg,and continuous iv infusion of propofol 4-7 mg·kg-1 · h-1,and remifentanil 0.2 μg· kg-1 · h-1 after birth.The response to endotracheal intubation was defined as positive when SP≥ 160 mmHg after intubation and maintained at this level for more than 1 min.The ED50,ED95 and 95 ％ confidence interval (CI) of remifentanil inhibiting responses to endotracheal intubation were calculated by probit analysis.Results The ED50 and ED95 (95％ CI) of remifentanil inhibiting responses to endotracheal intubation were 0.65 (0.53-0.77) μg/kg and 1.30 (1.10-1.70) μg/kg,respectively,in severely preeclamptic patients undergoing caesarean section.Conclusion When combined with propofol,the ED50 and ED95 of remifentanil inhibiting responses to endotracheal intubation in severely preeclamptic patients undergoing caesarean section are 0.65 and 1.30μg/kg,respectively.