成人不同濃度七氟醚誘導無肌松氣管插管時瑞芬太尼的半數有效量_《華西醫學》

作者：

馬慶軍 ,  劉松濤 , 伍湘儀 , 居熱提

新疆自治區人民醫院麻醉科（烏魯木齊，830001）;

關鍵詞：

七氟醚瑞芬太尼氣管插管全身麻醉

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【摘要】目的確定在不同濃度七氟醚復合瑞芬太尼誘導無肌松氣管插管時瑞芬太尼的半數有效量（ED50）。方法 2009年7月-2009年11月擇期手術患者60例，ASA I~II，年齡20~59歲，按照入室的順序隨機分為Ⅰ組（2%七氟醚組）和Ⅱ組（3%七氟醚組），預沖8%七氟醚誘導，眼瞼反射消失后，調節七氟醚呼氣末濃度分別維持在2%或3%，同時按照序貫法注入瑞芬太尼，瑞芬太尼注射90 s后氣管插管。記錄麻醉誘導前、患者意識消失時、插管前1 min、插管后1 min及插管后3 min心率、平均動脈壓的變化。結果 2%、3%的七氟醚復合瑞芬太尼誘導氣管插管時瑞芬太尼的半數有效量（ED50）及其相對應的95%可信區間分別為0.585 μg/kg及0.533～0.626 μg/kg和0.492 μg/kg及0.451～0.572 μg/kg。結論 2%、3%的七氟醚復合瑞芬太尼誘導氣管插管時瑞芬太尼的半數有效量及其相對應的95%可信區間分別為0.585 μg/kg及0.533～0.626 μg/kg和0.492 μg/kg及0.451～0.572 μg/kg。
【Abstract】 Objective To determine the half effective dose (ED50) of remifentanil dose for tracheal intubation without neuromuscular relaxant in adult when combined with different concentration of sevoflurane. Methods Sixty ASA Ⅰ to Ⅱ adult aged 20 to 59 years old, scheduled for elective surgery under general anesthesia were enrolled in this study between July 2009 to November 2009. All patients were ranged randomly into Group Ⅰ (2% sevoflurane) and Group Ⅱ (3% sevoflurane).Anesthesia was induced with 8% sevoflurane in 100% oxygenat at 6 L/min.After the loss of eyelash reflex, remifentanil was injected over 30 s, end-tidal sevoflurane concentration 2% or 3% was maitained. The dose of remifentanil was determined by up-and-down method. In 90 s after the end of bolus administration of remifentanil, the trachea was intubated. Mean blood pressure and heart rate were recorded at anaesthetic induction, the loss of eyelash reflex, before, in 1 min and 3 min after intubation. Results ED50 values (95% confidence intervals)of remifentanil for tracheal intubation during 2% and 3% sevoflurane induction without neuromuscular relaxant were 0.585 μg/kg and 0.533 - 0.626 μg/kg, and 0.492 μg/kg and 0.451 - 0.572 μg/kg, respectively. Conclusion ED50 values (95% confidence intervals)of remifentanil for tracheal intubation 2% and 3% sevoflurane induction without neuromuscular relaxant are 0.585 μg/kg (0.533 - 0.626 μg/kg) and 0.492 μg/kg (0.451 - 0.572 μg/kg), respectively.

引用本文： 馬慶軍,劉松濤,伍湘儀,居熱提. 成人不同濃度七氟醚誘導無肌松氣管插管時瑞芬太尼的半數有效量. 華西醫學, 2010, 25(7): 1303-1306. doi: 復制

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2.	Sivalingam P, Kandasamy R, Madhavan G, et al. Conditions for laryngeal mask insertion. A comparison of propofol versus sevoflurane with or without alfentanil[J]. Anaesthesia, 1999, 54(3): 271-276.
3.	Jaaskelinen SK, Kaisti K, Suni L, et al. Sevoflurane is epileptogenic in healthy subjects at surgical levels of anesthesia[J]. Neurology, 2003, 61(8): 1073-1078.
4.	Bordes M, Cros AM. Inhalation induction with sevoflurane in paediatrics: what is new?[Article in French][J]. Ann Fr Anesth Reanim, 2006, 25(4): 413-416.
5.	Sztark F, Chopin F, Bonnet A, et al. Concentration of remifentanil needed for tracheal intubation with sevoflurane at 1 MAC in adult patients[J]. Eur J Anaesthesiol, 2005, 22(12): 919-924.
6.	Lu W, Ramsay JG, Bailey JM. Reliability of pharmacodynamic analysis by logistic regression: mixed-effects modeling[J]. Anesthesiology. 2003, 99(6): 1255-1262. Comment in: Anesthesiology, 2003, 99(6): 1249-1250.
7.	Katoh T, Nakajima Y, Moriwaki G, et al. Sevoflurane requirements for tracheal intubation with and without fentanyl[J]. Br J Anaesth, 1999, 82(4): 561-565.
8.	Kim JY, Kwak YL, Lee KC, et al. The optimal bolus dose of alfentanil for tracheal intubation during sevoflurane induction without neuromuscular blockade in day-case anaesthesia[J]. Acta Anaesthesiol Scand, 2008, 52(1): 106-110.
9.	Bülow K, Nielsen TG, Lund J. The effect of topical lignocaine on intubating conditions after propofol-alfentanil induction[J]. Acta Anaesthesiol Scand, 1996, 40(6): 752-756.
10.	Striebel HW, Hlzl M, Rieger A, et al. Endotracheal intubation with propofol and fentanyl[Article in German][J]. Anaesthesist, 1995, 44(12): 809-817.
11.	Stevens JB, Wheatley L. Tracheal intubation in ambulatory surgery patients: using remifentanil and propofol without muscle relaxants[J]. Anesth Analg, 1998, 86(1): 45-49.
12.	Inomata S, Watanabe S, Taguchi M, et al. End-tidal sevoflurane concentration for tracheal intubation and minimum alveolar concentration in pediatric patients[J]. Anesthesiology, 1994, 80(1): 93-96.
13.	Kimura T, Watanabe S, Asakura N, et al. Determination of end-tidal sevoflurane concentration for tracheal intubation and minimum alveolar anesthetic concentration in adults[J]. Anesth Analg, 1994, 79(2): 378-381. .

1. Woods AW, Allam S. Tracheal intubation without the use of neuromuscular blocking agents[J]. Br J Anaesth, 2005, 94(2): 150-158.
2. Sivalingam P, Kandasamy R, Madhavan G, et al. Conditions for laryngeal mask insertion. A comparison of propofol versus sevoflurane with or without alfentanil[J]. Anaesthesia, 1999, 54(3): 271-276.
3. Jaaskelinen SK, Kaisti K, Suni L, et al. Sevoflurane is epileptogenic in healthy subjects at surgical levels of anesthesia[J]. Neurology, 2003, 61(8): 1073-1078.
4. Bordes M, Cros AM. Inhalation induction with sevoflurane in paediatrics: what is new?[Article in French][J]. Ann Fr Anesth Reanim, 2006, 25(4): 413-416.
5. Sztark F, Chopin F, Bonnet A, et al. Concentration of remifentanil needed for tracheal intubation with sevoflurane at 1 MAC in adult patients[J]. Eur J Anaesthesiol, 2005, 22(12): 919-924.
6. Lu W, Ramsay JG, Bailey JM. Reliability of pharmacodynamic analysis by logistic regression: mixed-effects modeling[J]. Anesthesiology. 2003, 99(6): 1255-1262. Comment in: Anesthesiology, 2003, 99(6): 1249-1250.
7. Katoh T, Nakajima Y, Moriwaki G, et al. Sevoflurane requirements for tracheal intubation with and without fentanyl[J]. Br J Anaesth, 1999, 82(4): 561-565.
8. Kim JY, Kwak YL, Lee KC, et al. The optimal bolus dose of alfentanil for tracheal intubation during sevoflurane induction without neuromuscular blockade in day-case anaesthesia[J]. Acta Anaesthesiol Scand, 2008, 52(1): 106-110.
9. Bülow K, Nielsen TG, Lund J. The effect of topical lignocaine on intubating conditions after propofol-alfentanil induction[J]. Acta Anaesthesiol Scand, 1996, 40(6): 752-756.
10. Striebel HW, Hlzl M, Rieger A, et al. Endotracheal intubation with propofol and fentanyl[Article in German][J]. Anaesthesist, 1995, 44(12): 809-817.
11. Stevens JB, Wheatley L. Tracheal intubation in ambulatory surgery patients: using remifentanil and propofol without muscle relaxants[J]. Anesth Analg, 1998, 86(1): 45-49.
12. Inomata S, Watanabe S, Taguchi M, et al. End-tidal sevoflurane concentration for tracheal intubation and minimum alveolar concentration in pediatric patients[J]. Anesthesiology, 1994, 80(1): 93-96.
13. Kimura T, Watanabe S, Asakura N, et al. Determination of end-tidal sevoflurane concentration for tracheal intubation and minimum alveolar anesthetic concentration in adults[J]. Anesth Analg, 1994, 79(2): 378-381. .

《華西醫學》

成人不同濃度七氟醚誘導無肌松氣管插管時瑞芬太尼的半數有效量

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《華西醫學》

成人不同濃度七氟醚誘導無肌松氣管插管時瑞芬太尼的半數有效量

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