不同剂量右美托咪定对依托咪酯抑制喉罩置入反应EC50的影响

摘要

目的 探讨不同剂量右美托咪定对依托咪酯抑制喉罩置入反应半数有效效应室浓度(EC50)的影响.方法 回顾性分析2014年8月～2015年8月诸暨市中医医院外科以乳腺肿瘤为诊断收入院的患者88例,随机分为对照组(A组)和实验组(B1、B2、B3组),每组22例,分别静脉泵入0.9％氯化钠溶液和右美托咪定(dexmedetomidine,DEX)(剂量依次为0.3、0.6、0.9 μg/kg),10 min后按上下序贯法静脉泵入依托咪酯.按序贯法计算各组患者置入喉罩时依托咪酯的EC50及其95％可信区间,监测麻醉过程中各组患者的生命体征变化及不良反应.结果 4组患者置入喉罩时依托咪酯的EC50及其95％可信区间分别为:A组0.78(0.723～0.835)μg/ mL,B1组0.66(0.612～0.711)μg/ mL,B2组0.58(0.532～0.627)μg/ mL,B3组0.46(0.416～0.521)μg/ mL;4组患者喉罩置入前即刻平均动脉压(MAP)及心率(HR)均低于基础值,差异有统计学意义(P <0.05),但在喉罩置入1 min后上升;对照组4例患者出现呼吸抑制,实验B3组3例患者出现心动过缓,2例患者出现低血压,经对症治疗后均好转.结论 在一定范围内,增大右美托咪定剂量可降低抑制喉罩置入反应的依托咪酯半数有效效应室浓度.%Objective To investigatethe EC50 of different doses of dexmedetomidine on etomidate inhibited responses tolaryngeal maskinsertion in patients.Methods 88 with breast cancerfrom surgical department in Zhuji Hospital of Traditional Chinese Medical from August 2014 to August 2015were selected and randomly divided into the control group(groupA)and the experiment group(group B1,group B2 and group B3)with 22 casesin each group,respectively,intravenous pump 0.9％sodium chloride solution and DEX(dose followed by 0.3,0.6,0.9μg/kg).The next sequential intravenous infusion of etomidateafter 10 min.The EC50 and the 95％confidence interval of etomidate were determined by sequential method in each group of patients,the changes of vital signs and adverse reactionsin patients were monitored.Results Four groups of patients with LMA EC50 and 95％confidence interval of etomidate respectively:0.78(0.723～0.835)μg/mL in group A,0.66(0.612～0.711)μg/mL in group B1,0.58(0.532～0.627)μg/mL in group B2,0.46(0.416～0.521)μg/mL in group B3.Four groups of patients with laryngeal mask insertion immediately before MAP and HR were lower than the baseline value,the difference was statistically significant(P<0.05),but the LMA elevated after one min.The control group of four patients with respiratory depression,three cases of patients with bradycardia in group B3,two cases of patients with hypotension were improved after symptomatic treatment.Conclusion In a certain range,increasing the dose of dexmedetomidine reduces the effective concentration of etomidate,which inhibits the laryngeal mask placement reaction.