【摘要】 目的 确定在不同浓度七氟醚复合瑞芬太尼诱导无肌松气管插管时瑞芬太尼的半数有效量（ED50）。 方法 2009年7月-2009年11月择期手术患者60例，ASA I~II，年龄20~59岁，按照入室的顺序随机分为Ⅰ组（2%七氟醚组）和Ⅱ组（3%七氟醚组），预冲8%七氟醚诱导，眼睑反射消失后，调节七氟醚呼气末浓度分别维持在2%或3%，同时按照序贯法注入瑞芬太尼，瑞芬太尼注射90 s后气管插管。记录麻醉诱导前、患者意识消失时、插管前1 min、插管后1 min及插管后3 min心率、平均动脉压的变化。 结果 2%、3%的七氟醚复合瑞芬太尼诱导气管插管时瑞芬太尼的半数有效量（ED50）及其相对应的95%可信区间分别为0.585 μg/kg及0.533～0.626 μg/kg和0.492 μg/kg及0.451～0.572 μg/kg。 结论 2%、3%的七氟醚复合瑞芬太尼诱导气管插管时瑞芬太尼的半数有效量及其相对应的95%可信区间分别为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.
目的:观察七氟醚靶控用于低流量吸入麻醉维持的临床规律及血流动力学变化,寻求靶控下的药物量化指标。方法:选择60例20～60岁手术患者,随机分2组每组30例:P组(丙泊酚)常规实施全凭静脉TCI靶控麻醉;S组(七氟醚),实施低流量七氟醚靶控吸入麻醉(BIS值40)。分别记录诱导前(T1),插管后5(T2)、15(T3)、30(T4)45(T5)、60(T6)、90(T7)、120(T8)min时的、MBP、HR、;Sev组患者加记各个时点的七氟醚IT、ET的MAC值。结果:T2点两组均比T1 降低(Plt;0.05),S 组高于P组(Plt;0.05),两组比较T3至T7无显著性差异(Pgt;0.05);S 组T3 至T7 各点ET值无统计学差异,ET%:2.46,约1.4 MAC。结论:(1)七氟醚诱导较静脉麻醉诱导患者血流动力学稳定,(2)低流量七氟醚靶控吸入麻醉维持平稳,调控简便,效果良好。