| 摘要: |
| 目的探讨瑞芬太尼复合依托咪酯抑制老年高血压患者气管插管心血管反应的半数有效剂量（ED50）。方法对60例择期行全麻手术的老年患者根据基础血压分为高血压组（观察组）和非高血压组（对照组），每组30例。使用序贯法探索复合依托咪酯和罗库溴铵诱导时，瑞芬太尼抑制插管反应的ED50。瑞芬太尼初始效应室靶浓度为3ng/ml（浓度梯度差为0.2ng/ml），若发生气管插管反应阳性时，则下一例患者升高一级浓度，反之则降低一级浓度梯度。气管插管反应阳性的定义为收缩压（SBP）升高≥20％基础值。计算瑞芬太尼抑制患者气管插管时心血管反应的ED50及其95％CI。结果复合依托咪脂诱导时，瑞芬太尼抑制老年患者气管插管心血管反应的ED5095％CI：高血压组为3.56（3.37～3.74）ng/ml，高于对照组的3.02（2.87～3.17）ng/ml（P＜0.05）。结论抑制老年高血压患者气管插管心血管反应需要更多的瑞芬太尼剂量，其复合依托咪酯抑制插管反应的ED50为3.56ng/ml。 |
| 关键词: 瑞芬太尼 依托咪酯 剂量效应关系 气管插管 血流动力学参数 |
| DOI：10.12056/j.issn.1006-2785.2018.40.10.2017-2076 |
| 分类号: |
| 基金项目: |
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| Median effective dose of remifentanyl for blunting hemodynamic response to tracheal intubation in elderly patients with hypertension |
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Department of Anesthesiology，shulan（hangzhou） Hospital
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| Abstract: |
| Objective To investigate the median effective dose (ED50) of remifentanyl for blunting the hemodynamic response to tracheal intubation in elderly patients with hypertension. Methods Sixty elderly patients undergoing elective surgery with general anesthesia were enrolled in this study, including 30 cases with hypertension and 30 non-hypertensive cases. Induction was performed with remifentanyl target-controlled infusion, intravenous injection of etomidate and norurium. Dixon's up-down method was used to obtain ED50 of target concentration of remifentanyl in two groups. The initial dose of target concentration of remifentanyl was 3 ng/mL (step size was 0.2 ng/ml), and the dose was increased by 0.2 ng/ml for the next patient if the patient exhibited an intubation reaction; otherwise, the dose was decreased by 0.2 ng/ml for the next patient. The intubation
reaction was defined as systolic blood pressure increased ＞20% of the baseline value．The ED50 (95％ confidence interval) of
remefentanyl for blunting tracheal intubation reaction was calculated. Results ED50 (95％ confidence interval) of remifentanyl for blunting the hemodynamic response to tracheal intubation in elderly patients with hypertension was 3.56 (3.37～3.74) ng/L, which was higher than that in control group 3.02 (2.87～3.17) ng/ml (P＜0.05)． Conclusion ED50 of remifentanyl for blunting the hemo- dynamic response to tracheal intubation was 3.56 ng/ml in elderly patients with hypertension, which was higher than non-hyper- tensive patients. |
| Key words: Remifentanil Etomidate Dose-response relationship Intubation Haemodynamics |
