CAJ | 학술논문

目的探讨芬太尼对异丙酚抑制高龄患者肠镜检查体动反应半数有效血浆浓度的影响。方法择期行肠镜检查术的高龄患者90例，男性45例，女性45例，年龄（81±7）岁（75～89岁），A S AⅡ～Ⅲ级，体质量指数19～27 kg／m2。采用随机数字表法，将患者分为3组（n＝30），即生理盐水对照组（C组）和不同剂量芬太尼组（F0．5组、F1．0组）。采用血浆靶控输注（TCI）异丙酚，3组初始靶浓度为2．0μg／mL ，达靶浓度后，C组、F0．5组、F1．0组分别静脉注射芬太尼0，0．5，1．0μg／kg（用生理盐水稀释至5mL），3min后行肠镜检查术。检查过程中如患者出现头部或四肢有目的的较大动作，则定义为肠镜检查诱发的体动反应。采用序贯法确定异丙酚血浆靶浓度，相邻浓度值差0．5μg／mL ，出现体动反应者，下一例采用高一级浓度；若未出现体动反应，则采用低一级浓度。用概率单位法确定异丙酚半数有效血浆浓度（EC50）及其95％可信区间（CI）。结果 C组、F0．5组、F1．0组的 EC50及其95％ CI分别为3．05（2．72～3．36），2．76（2．45～3．09），2．20（1．72～2．67）μg／mL ，异丙酚 EC50呈递减趋势（P＜0．05）。结论高龄患者行肠镜检查术时，随着复合芬太尼剂量的增加，异丙酚抑制肠镜检查术诱发的体动反应的EC50随之递减。
목적탐토분태니대이병분억제고령환자장경검사체동반응반수유효혈장농도적영향。방법택기행장경검사술적고령환자90례，남성45례，녀성45례，년령（81±7）세（75～89세），A S AⅡ～Ⅲ급，체질량지수19～27 kg／m2。채용수궤수자표법，장환자분위3조（n＝30），즉생리염수대조조（C조）화불동제량분태니조（F0．5조、F1．0조）。채용혈장파공수주（TCI）이병분，3조초시파농도위2．0μg／mL ，체파농도후，C조、F0．5조、F1．0조분별정맥주사분태니0，0．5，1．0μg／kg（용생리염수희석지5mL），3min후행장경검사술。검사과정중여환자출현두부혹사지유목적적교대동작，칙정의위장경검사유발적체동반응。채용서관법학정이병분혈장파농도，상린농도치차0．5μg／mL ，출현체동반응자，하일례채용고일급농도；약미출현체동반응，칙채용저일급농도。용개솔단위법학정이병분반수유효혈장농도（EC50）급기95％가신구간（CI）。결과 C조、F0．5조、F1．0조적 EC50급기95％ CI분별위3．05（2．72～3．36），2．76（2．45～3．09），2．20（1．72～2．67）μg／mL ，이병분 EC50정체감추세（P＜0．05）。결론고령환자행장경검사술시，수착복합분태니제량적증가，이병분억제장경검사술유발적체동반응적EC50수지체감。
Objective To determine the effects of fentanyl on the EC50 of propofol inhibiting co‐loscopy induced body dynamic response in elderly patients . Mehthods Electly coloscopy 90 patients , aged 75~89 years ,ASA grade Ⅱor Ⅲ ,body mass index 19~27 kg/m2 . The patients were randomly de‐vided into three groups (n=30) ,saline control group (group C) and different doses of fentanyl group (F0 .5 group ,F1 .0 group) . Using plasma target‐controlled (TCI) of propofol infusion for three groups ,the ini‐tial target concentration was 2μg/mL . After the target concentrations of plasma and effect‐site of propo‐fol were balanced ,group C ,F0 .5 group and F1 .0 group) intravenous injection of fentanyl were 0 ,0 .5 , 1 .0 μg/kg (diluted with saline to 5 mL) respectively . 3 minunes later underwent colonoscopy surgery . If the patient has the head or limbs to larger movements ,is determined to body movement . Using the se‐quential method to determine the plasma concentration of propofol ,adjacent concentration difference of 0 .5 μg/mL ;body movement occurs responders ,the next one case high a concentration ;if there is not movement in response ,then the use of low‐level concentrations of . Determined by probit propofol EC50 and its 95% confidence interval (CI) . Results Group C ,F0 .5 group and F1 .0 group propofol EC50 and 95% CI were 3 .05 (2 .72~3 .36) ,2 .76 (2 .45~3 .09) and 2 .20 (1 .72~ 2 .67) μg/mL .Propofol EC50 showed a decreasing trend (P<0 .05) . Conclusion The EC50 of propofol for fibercolonoscope examina‐tion was 3 .05 ,2 .76 ,2 .20 μg/mL respectively of the three group .