【作者】 刘玲；

【导师】 吕国义；

【作者基本信息】 天津医科大学 ， 麻醉学（专业学位）， 2015， 硕士

【摘要】 目的:本研究的目的主要有以下几个方面,首先测算单独靶控输注丙泊酚时,老年患者意识消失时的半数有效效应室浓度;然后测算复合丙泊酚分步靶控输注时舒芬太尼抑制老年患者喉罩置入反应的半数有效效应室浓度及诱导期舒芬太尼的用药量。为老年患者麻醉用药提供临床依据。方法:经医院伦理委员会同意,选择拟在全麻下行择期手术的老年患者120例,其中60例患者年龄在66-70岁,平均分为A组和AL组;其余60例患者年龄在71-75岁,平均分为B组和BL组。所有患者进入手术室后用同一型号的静脉留置针开放右侧外周静脉,后给予咪达唑仑0.02mg/kg。患者平静10分钟后开始全麻诱导,A组和B组患者均是以效应室靶浓度分步靶控输注丙泊酚,初始效应室靶浓度为1μg/ml,两分钟后将浓度增加至平衡靶浓度,当患者的效应室靶浓度与血浆浓度平衡时,观察患者的OAA/S评分和BIS值,OAA/S≤1、BIS≤60时认为意识消失。按改良序贯法选择下一例患者丙泊酚的平衡效应室靶浓度,相邻平衡靶浓度之比为1.2。计算老年患者意识消失时的半数有效效应室靶浓度。AL组BL组两组患者。所有患者进入手术室后用同一型号的静脉留置针开放右侧外周静脉,后给予咪达唑仑0.02mg/kg。患者平静10分钟后开始全麻诱导,均是同时以效应室靶浓度靶控输注丙泊酚和舒芬太尼。丙泊酚的靶控输注分为两步,初始效应室靶浓度为1μg/ml,2分钟后增加至2μg/ml。舒芬太尼的起始效应室靶浓度设为0.3ng/ml,按改良序贯法选择下一例患者舒芬太尼效应室靶浓度,相邻浓度之比为1.2。当舒芬太尼血浆浓度和效应室浓度平衡,且OAA/S≤1、BIS≤60时,由同一麻醉医师置入喉罩。观察两组患者的插管反应和血流动力学变化,并记录全麻诱导前(T0)、喉罩置入即刻(T1)、喉罩置入后1min(T2)、喉罩置入后2min(T3)和喉罩置入后5min(T4)时的MAP、HR及BIS值。利用Probit回归分析法计算各组的半数有效效应室浓度(EC50)和95%置信区间(CI),以及舒芬太尼的诱导用量和95%CI。结果:A组患者意识消失时丙泊酚的半数有效效应室靶浓度为1.57μg/ml,95%CI为(1.05~1.93)μg/ml,B组患者意识消失时丙泊酚的半数有效效应室靶浓度为1.45μg/ml,95%CI为(0.98~1.72)μg/ml;AL组患者舒芬太尼抑制喉罩置入反应的半数有效效应室浓度为0.164ng/ml,95%CI为(0.144~0.182)ng/ml,诱导期舒芬太尼的平均用量为0.171±0.039μg/kg;BL组患者舒芬太尼抑制喉罩置入反应的半数有效效应室浓度为0.160ng/ml,95%CI为(0.141~0.179)ng/ml,诱导期舒芬太尼的平均用量为0.169±0.042μg/kg。结论:复合丙泊酚分步TCI时,舒芬太尼抑制60-69岁老年患者喉罩置入反应的EC50为0.164ng/ml,95%CI为(0.141~0.179)ng/ml,舒芬太尼的平均诱导用量为0.171±0.039μg/kg;舒芬太尼抑制70-79岁老年患者喉罩置入反应的EC50为0.160ng/ml,95%CI为(0.141~0.179)ng/ml,舒芬太尼的平均诱导用量为0.169±0.042μg/kg。两组患者舒芬太尼的效应室靶浓度差异无统计学意义,p>0.05,但是,B组患者T1时刻比T0时刻较A组患者血压下降幅度大,p<0.05。因此,老年患者诱导期的应注意减少丙泊酚的用量,而60-79岁的患者舒芬太尼的敏感性无明显差异。更多还原

【Abstract】 Objective To determine the half effective concentration of sufentanil on propofol to prevent laryngeal mask insertion response in elderly patients. Methods 120 low risk patients undergoing elective surgery under general anesthesia were included in this study. Patients were allocated into A and B groups.There were 30 old patients in group A and group AL,aged 66-70 and 30 patients in group B and group BL,aged 71-75. Propofol was administered by the March pharmacokinetic model TCI system in two stpes.The target effect-site concentration(Ce) of propofol was administered from 1μg/ml to 2μg/ml. The interval between the two concentrations was 2min. Sufentanil was first administered 0.3ng/ml with a target effect-site concentration(Ce). The laryngeal mask was inserted by the same anesthetist after sufentanil achieving the balance of target effect-site concentration and plasma concentration.The next concentration of sufentanil was determined using the modified Dixon’s up-and-down method. The ratio between adjacent concentrations was 1:1.2. The changes in cardiovascular response and BIS were recorded. Modified OAA/S sedation score were measured.Probability analysis was used for calculating EC50 and 95% confidence interval(CI). Results The EC50 cf sufentanil on propofol to prevent laryngeal mask insertion response in elderly patients aged 66-70 was 0.164ng/ml, 95%CI was 0.144~0.182ng/ml. The EC50 cf sufentanil on propofol to prevent laryngeal mask insertion response in elderly patients aged 71-75 was 0.160ng/ml, 95%CI was 0.141~0.179ng/ml. Conclusion The EC50 cf sufentanil on propofol to prevent laryngeal mask insertion response in elderly patients aged 66-70 was 0.164ng/ml, 95%CI was 0.144~0.182ng/ml. The EC50 cf sufentanil on propofol to prevent laryngeal mask insertion response in elderly patients aged 71-75 was 0.160ng/ml, 95%CI was 0.141~0.179ng/ml. There were no difference between the two groups, p>0.05.更多还原