右美托咪定對七氟醚麻醉下小兒無肌鬆氣管插管時瑞芬太尼半數有效血漿靶濃度的影響
麻醉與鎮痛
作者：莫利群等
[摘要] 目的 觀察右美托咪定對七氟醚麻醉下小兒無肌鬆氣管插管時瑞芬太尼半數有效血漿靶濃度（CP50）的影響。方法 擇期全麻手術患兒51例，年齡3～6歲，ASAⅠ～Ⅱ級，隨機分為右美托咪定組（D組，n=25）和對照組（C組，n=26）。D組和C組分別靜脈輸注右美托咪定0.5 μg/kg和生理鹽水，吸入七氟醚維持呼氣末濃度為2.7%，靶控輸注瑞芬太尼，初始血漿靶濃度分別為3.5 ng/mL和4.0 ng/mL，相鄰濃度梯度為0.5 ng/mL，采用序貫法進行試驗，氣管插管在效應室靶濃度和血漿靶濃度相同時進行。瑞芬太尼的CP50及95%可信區間（95%CI）采用Probit檢驗。結果 D組瑞芬太尼的CP50為3.34 ng/mL，其95%CI為2.77～3.82，C組瑞芬太尼的CP50為4.10 ng/mL，其95%CI為3.60～4.59，差異有統計學意義（P
[關鍵詞] 右美托咪定；瑞芬太尼；插管法；氣管內；劑量效應關係
[中圖分類號] R726.1 [文獻標識碼] B [文章編號] 1673-9701（2015）09-0104-03
Effect of dexmedetomidine on half-effective target plasma concentration of remifentanil needed for tracheal intubation without neuromuscular relaxant in children when combined with sevoflurane inhalation
MO Liqun WU Gangming SONG Li
Department of Anesthesiology， the Affiliated Hospital of Luzhou Medical College， Luzhou 646000， China
[Abstract] Objective To investigate the effect of dexmedetomidine on half-effective target plasma concentration（CP50） of remifentanil needed for tracheal intubation without neuromuscular relaxant in children when combined with sevoflurane inhalation. Methods A total of 51 children aged 3-6 years old， ASAⅠ-Ⅱ undergoing elective surgery under general anesthesia were randomLy allocated into 2 groups： dexmedetomidine group （group D， n=25） and control group （group C， n=26）. In group D dexmedetomidine 0.5 μg/kg was infused while in group C equal volume saline was infused instead of dexmedetomidine. Sevoflurane was inhalated and the concentration was adjusted to 2.7% of end-tidal concenration. Remifentanil was administered by target-controlled infusion. Target plasma concentration of remifentanil was determined by up-and-down sequential trial. The initial target plasma remifentanil concentration was set at 3.5 ng/mL and 4.0 ng/mL in group D and group C. The gradient of two target plasma concentrations was 0.5 ng/mL. Tracheal intubation was performed after the equilibration between plasma and effect-site concentration. The CP50 and 95% confidence interval （95%CI） of remifentanil were determined by probit analysis. Results The CP50 of remifentanil was 3.34 ng/mL （95%CI 2.77-3.82） and 4.10 ng/mL（95%CI 3.60-4.59） in group D and group C respectively. The CP50 of remifentanil was significantly lower in group D than in group C. Conclusion Dexmedetomidine 0.5 μg/kg can decrease CP50 of remifentanil needed for tracheal intubation without neuromuscular relaxant in children when combined with 2.7% sevoflurane inhalation.