国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2015年
1期
1-5
,共5页
钱淑雯%郭旋%张马忠%杨志萍
錢淑雯%郭鏇%張馬忠%楊誌萍
전숙문%곽선%장마충%양지평
丙泊酚%瑞芬太尼%脑电双频指数%药效学模型%反应曲面
丙泊酚%瑞芬太尼%腦電雙頻指數%藥效學模型%反應麯麵
병박분%서분태니%뇌전쌍빈지수%약효학모형%반응곡면
Propofol%Remifentanil%Bispectral index%Pharmacodynamic model%Response surface
目的 以脑电双频指数(bispectral index,BIS)为指标,观察不同丙泊酚-瑞芬太尼浓度组合产生的镇静效应,构建丙泊酚和瑞芬太尼相互作用的反应曲面模型,确定量效关系及相互作用类型,并分析这种相互作用对BIS临床监测的提示.方法 采用交叉对照研究;无术前用药、美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级、择期行全麻手术的患者40例,按随机数字表法分为丙泊酚组(22例)和瑞芬太尼组(18例).以靶控输注方式分两个阶段递增和递减药物浓度(丙泊酚,1 mg/L～5 mg/L;瑞芬太尼,1 μg/L～7 μg/L),经洗脱期后,给予第2种药物.每间隔1 min采集BIS指标,采用非线性混合效应模型对研究数据进行分析. 结果 丙泊酚和瑞芬太尼相互作用对BIS影响的药效学模型以Minto反应曲面模型较好拟合;两药对BIS表现为协同作用(相互作用系数β2＞0);年龄不影响两药的50％有效浓度(50％ effective concentration,EC50),但对斜率(γ)有显著影响(P＜0.01).反应曲面模型的参数分别为EC50.Prop=2.96 mg/L,EC50.Reni=38.1 μg/L,γ=1.86+(年龄-50)0.017 2,Eman=8.61,E0=90.8,β2=0.83.结论 丙泊酚联合瑞芬太尼有镇静协同效应;年龄不影响BIS降低的幅度(Emax不变),也不影响两药联合作用的敏感性(EC50不变),但老年人联合用药时BIS的反应性增加(γ随年龄增加而增加).
目的 以腦電雙頻指數(bispectral index,BIS)為指標,觀察不同丙泊酚-瑞芬太尼濃度組閤產生的鎮靜效應,構建丙泊酚和瑞芬太尼相互作用的反應麯麵模型,確定量效關繫及相互作用類型,併分析這種相互作用對BIS臨床鑑測的提示.方法 採用交扠對照研究;無術前用藥、美國痳醉醫師協會(ASA)分級Ⅰ～Ⅱ級、擇期行全痳手術的患者40例,按隨機數字錶法分為丙泊酚組(22例)和瑞芬太尼組(18例).以靶控輸註方式分兩箇階段遞增和遞減藥物濃度(丙泊酚,1 mg/L～5 mg/L;瑞芬太尼,1 μg/L～7 μg/L),經洗脫期後,給予第2種藥物.每間隔1 min採集BIS指標,採用非線性混閤效應模型對研究數據進行分析. 結果 丙泊酚和瑞芬太尼相互作用對BIS影響的藥效學模型以Minto反應麯麵模型較好擬閤;兩藥對BIS錶現為協同作用(相互作用繫數β2＞0);年齡不影響兩藥的50％有效濃度(50％ effective concentration,EC50),但對斜率(γ)有顯著影響(P＜0.01).反應麯麵模型的參數分彆為EC50.Prop=2.96 mg/L,EC50.Reni=38.1 μg/L,γ=1.86+(年齡-50)0.017 2,Eman=8.61,E0=90.8,β2=0.83.結論 丙泊酚聯閤瑞芬太尼有鎮靜協同效應;年齡不影響BIS降低的幅度(Emax不變),也不影響兩藥聯閤作用的敏感性(EC50不變),但老年人聯閤用藥時BIS的反應性增加(γ隨年齡增加而增加).
목적 이뇌전쌍빈지수(bispectral index,BIS)위지표,관찰불동병박분-서분태니농도조합산생적진정효응,구건병박분화서분태니상호작용적반응곡면모형,학정량효관계급상호작용류형,병분석저충상호작용대BIS림상감측적제시.방법 채용교차대조연구;무술전용약、미국마취의사협회(ASA)분급Ⅰ～Ⅱ급、택기행전마수술적환자40례,안수궤수자표법분위병박분조(22례)화서분태니조(18례).이파공수주방식분량개계단체증화체감약물농도(병박분,1 mg/L～5 mg/L;서분태니,1 μg/L～7 μg/L),경세탈기후,급여제2충약물.매간격1 min채집BIS지표,채용비선성혼합효응모형대연구수거진행분석. 결과 병박분화서분태니상호작용대BIS영향적약효학모형이Minto반응곡면모형교호의합;량약대BIS표현위협동작용(상호작용계수β2＞0);년령불영향량약적50％유효농도(50％ effective concentration,EC50),단대사솔(γ)유현저영향(P＜0.01).반응곡면모형적삼수분별위EC50.Prop=2.96 mg/L,EC50.Reni=38.1 μg/L,γ=1.86+(년령-50)0.017 2,Eman=8.61,E0=90.8,β2=0.83.결론 병박분연합서분태니유진정협동효응;년령불영향BIS강저적폭도(Emax불변),야불영향량약연합작용적민감성(EC50불변),단노년인연합용약시BIS적반응성증가(γ수년령증가이증가).
Objective Based on bispectral index (BIS) monitoring,the sedative effect produced by the combination of propofol and remifentanil with variable concentrations was observed.In order to construct the pharmacodynamic response surface model of propofol and remifentanil and to determine the dose effect relationship and interaction type.Methods With a cross-control design,forty patients without premedication,ASA Ⅰ-Ⅱ grade,undergoing elective surgery,were randomly divided into propofol group and remifentanil group.Propofol or remifentanil was used with target-controlled infusion system in two phases of increment and decrement drug concentration (propofol 1 mg/L-5 mg/L,remifentanil 1 μg/L-7 μμg/L),after the washout period,giving the second drug.Each collects intervally BIS index every 1 min,use nonlinear mixed effects models to analyze the data for research.Results The concentration-BIS relationship of propofol combined with remifentanil was described well by Minto response surface model,which showed considerable synergy between both drugs for BIS (interaction index β2＞0).Age does not affect the 50％ effective concentration (EC50) of both drugs,but has a significant effect on γ (P＜0.01).The final pharmacodynamic parameters were followings:EC50,Prop=2.96 mg/L,EC50.Remi=38.1 μg/L,Gamma (γ)=1.86+(age-50)0.017 2,Emax=8.61,E0=90.8 and β2=0.83,respectively.Conclusions Propofol-remifentanil shows a synergistic interaction on sedation.Age does not affect the decreasing amplitude(unchanged Emax) and the sensitivity(unchanged EC50) of BIS produced by combination of both drugs,but the elderly have increased BIS reaction (increased gamma with aging) to the combination of both drugs.
