明视喉镜可降低一定瑞芬太尼浓度下异丙酚抑制插管反应的半数有效靶控浓度

摘要

目的 观察对比明视喉镜与直接喉镜下插管时,异丙酚抑制心血管应激反应的半数有效靶控浓度(EC50).方法 选择经口气管插管全身麻醉下手术患者80例,将患者按照数字随机法分为对照组(采用传统直接喉镜插管)和观察组(采用明视喉镜气管插管),两组患者一般情况差异无统计学意义,诱导药物除异丙酚外其他麻醉药物输注方式及剂量均相同.分别序贯测定两组患者异丙酚抑制插管应激反应的EC50,第1例患者异丙酚血药浓度均设定为4μg/ml,两相邻患者靶控浓度比值为1.2,根据应激反应[即平均动脉压(MAP)或心率(HR)较基础值上升≥15%]是否消失决定下位患者靶控浓度升降,前一位患者应激反应消失则下一位减少一个浓度梯度,前一位患者应激反应未消失则下一位增加一个梯度,依此类推.结果 对照组抑制插管心血管反应的异丙酚EC50及其95%CI为5.19μg/ml(95%CI:4.88~5.50μg/ml).观察组抑制插管心血管反应的异丙酚EC50及其95%CI为4.15μg/ml(95%CI:3.80~4.40μg/ml).观察组抑制插管心血管反应的异丙酚EC50及95%CI明显低于对照组(P<0.05).两组MAP与HR在T1时刻差异无统计学意义(P>0.05),在T2时刻均较T1时升高(P<0.05),而且观察组明显低于对照组(P<0.05).对照组的MAP与HR在T3时刻较T1下降(P<0.05),而观察组则无明显差异(P>0.05).结论 明视喉镜引导下气管插管,抑制插管心血管反应的异丙酚EC50及95%可信区间明显低于直接喉镜下插管,诱导插管期的循环更平稳.%Objective To compare the EC50 of Propofol for inhibiting intubation response. Methods 80 cases un-derwent tracheal intubation general anesthesia, all patients were randomly divided into two groups. The general situ-ation between the two groups showed no significant difference. Except for Propofol, other anesthesia drugs infusion method and dosage were the same. Sequential determination the EC50 of Propofol which for inhibiting intubation re-sponse of each groups by up-and-down. Propofol target concentration of the first patient was set to 4 μg/ml, and ad-justed according to intubation stress response disappeared or not, concentration of two adjacent patients with ratio of 1.2. Results A group inhibited the cardiovascular responses of Propofol EC50 and 95%CI was 5.19 μg/ml (95%CI:4.88 ~ 5.50 μg/ml). B group inhibited the cardiovascular responses of Propofol EC50 and 95 %CI was 4.15μg/ml (95%CI:3.80~4.40μg/ml). The EC50 and 95% confidence interval of the B group were significantly lower than those of the A group ( P< 0.05). The MAP and HR at T2 were higher than that of T1 in each group ( P< 0.05), and the MAP and HR of observe group were lower than that of control group ( P< 0.05). The MAP and HR at T3 were lower than that of T1 in control group ( P< 0.05), but there were no significant deference in observe group ( P> 0.05).Conclusion The EC50 and 95% confidence interval of Propofol for inhibiting intubation response under photopic laryngoscopes was significant lower than those of under direct laryngoscopes, the circulation during period of induc-tion and intubation was more stable.