依托咪酯对丙泊酚抑制气管插管反应EC50的影响

摘要

目的:测定复合依托咪酯诱导时丙泊酚抑制气管插管反应半数有效浓度(EC50)、95%可信区间(CI95)及其对血流动力学的影响.方法:60例择期气管内全麻手术患者随机分为对照组(C组)和观察组(D组,n=30).C组单纯靶控输注丙泊酚,D组靶控输注丙泊酚的同时复合靶控输注0.33μg/mL依托咪酯.根据预实验观察结果,两组丙泊酚初始靶浓度均设为2.5μg/mL.依观察插管反应,决定下1例丙泊酚靶浓度.记录入室时(T0)、插管前即刻(T1)和插管后1、3、5 min(T2~4)平均动脉压(MAP)、心率(HR).结果:C组丙泊酚抑制气管插管反应的EC50、CI95为1.95(1.76~2.22)μg/mL,D组1.46(1.29~1.64)μg/mL(P<0.05).与T0时刻比较,两组T1、T2时MAP、HR均有所下降,C组下降更显著.结论:依托咪酯可明显降低丙泊酚抑制气管插管的心血管反应EC50,依托咪酯复合丙泊酚较单纯丙泊酚靶控诱导,血流动力学更趋平稳.%Objective To test the value of EC50 and its 95% reliable interval of propofol inhibiting endotra-cheal intubation response when combining etomidate in anaesthesia induction, and to observe and record the he-modynamic indexes. Methods Total 60 patients who will undergo endotracheal intubation of general anesthe-sia surgery, ASA class I~II, were divided into two groups randomly, 30 patients in each group: Group C was control group, in which plasma target controlled infusion of propofol was performed alone. Group D was observa-tion group, in which plasma target controlled infusion of propofol was performed and target controlled infusion of etomidate at the concentration of 0.33 μg/mL was performed also. According to preliminary experiment, the ini-tial target plasma concentration of propofol in each group was set at 2.5 μg/mL. Determination of the target con-trolled concentration of propofol in next case was based on the response of intubation. The value of MAP and HR at entering the room(T0), the moment of just before the intubation(T1), as well as 1,3,5 min(T2-4)after the intubation were recorded. Results The EC50 (CI95) of propofol inhibiting the sympathetic response of intuba-tion in Group C was 1.95(1.76~2.22)μg/mL, but 1.46(1.29~1.64)μg/mL in group D. Compared with that in Group C, the EC50 of propofol in group D decreased significantly (P<0.05). Compared with T0 period, the value of MAP and HR in two groups was declined significantly at T1 and T2 period. The value of MAP and HR in Group C was declined more obviously. Conclusion The use of etomidate can reduce the EC50 of propofol in-hibiting the sympathetic response when inbutation. The hemodynamics are more stable when using etomidate combining propofol target controlled infusion.