摘要：
目的 探讨瑞芬太尼联合丙泊酚全凭静脉麻醉时,抑制患者气管拔管期循环反应的瑞芬太尼靶控输注(target controlled infusion,TCI)血浆靶浓度的半最大效应浓度(concentration for 50％ of maximal effect,EC50),以指导临床麻醉. 方法 纳入2016年6～8月于我院接受非心脏手术的全身麻醉患者30例,ASA分级Ⅰ、Ⅱ级.所有患者均在BIS监控下行瑞芬太尼联合丙泊酚全凭静脉麻醉诱导,手术结束缝皮时停用丙泊酚,并将瑞芬太尼调整至试验浓度.根据上下序贯法原则设定瑞芬太尼试验浓度,第1例患者瑞芬太尼血浆靶浓度2 μg/L,间隔浓度为0.2 μg/L.记录患者麻醉诱导前(T1),拔管期瑞芬太尼达到试验浓度时(T2),拔管即刻(T3),拔管后1 min(T4)、2 min(T5)、3 min(T6)、4 min(T7)、5 min(T8)时的MAP和HR. 结果 所有手术均在患者接受单次肌松药下成功完成,手术时间均在2h内,术中未见严重应激反应、心动过缓及低血压等不良事件发生,术后未见皮肤瘙痒、疼痛、恶心呕吐等并发症,拔管时6例患者出现呛咳.根据序贯法,瑞芬太尼抑制拔管期循环反应的EC50为1.637 μg/L,其95％CI=1.481～1.769 μg/L. 结论 瑞芬太尼联合丙泊酚全凭静脉麻醉时,抑制50％患者气管拔管期循环反应的瑞芬太尼TCI血浆靶浓度为1.637 μg/L.%Objective To investigate the concentration of remifentanil for inhibiting 50％ patients from circulatory response (EC50) during extubation under total intravenous anesthesia,in order to guide clinical anesthesia.Methods A total of 30 ASA Ⅰ or Ⅱ patients without cardiac surgery under general anesthesia from June to August 2016 in our hospital were included.Anesthesia were induced by remifentanil combined with propofol under BIS monitoring.Propofol was discontinued at the end of operation,and remifentanil doses were adjusted to test concentrations.According to the up-and-down method,the concentration of remifentanil was set as follows:the target plasma concentration of remifentanil was 2 μg/L for the first patients,with an interval concentration of 0.2 μg/L.Then,the MAP and HR were recorded before anesthesia induction (T1),when remifentanil dose reached test concentrations before extubation(T2),immediately after extubation(T3),1 min(T4),2 min(T5),3 min(T6),4 min(T7),and 5 min(T8) after extubation.Results All the operations were completed successfully and all patients received a single dose of muscle relaxants.The operation time was less than 2 h.There were no severe stress response,bradycardia and hypotension and other adverse events during operation.No skin itching,pain,nausea and vomiting and other complications were reported after extubation.There were 6 patients who coughed after extubation.According to the up-and-down method,EC50 of remifentanil for inhibiting circulatory response was 1.637 μg/L (95％CI=1.481-1.769 μg/L).Conclusions When remifentanil and propofol are used in combination for total intravenous anesthesia,the concentration of remifentanil for inhibiting 50％ patients from circulatory response during extubation was 1.637 μg/L.
