不同浓度瑞芬太尼对丙泊酚抑制胃镜置入反应半数有效浓度及麻醉质量的影响

Effects of different concentrations of remifentanil on the effective concentration 50%and anesthetic quality to propofol inhibiting gastroscopy

摘要:

目的： 探讨不同浓度瑞芬太尼对丙泊酚靶控输注（target controlled infusion，TCI）患者胃镜置入反应半数有效浓度（effective concentration 50%，EC₅₀）及麻醉质量的影响。方法： 150例行内镜下黏膜切除术（endoscopic mucosal resection，EMR）患者，年龄（59.11±10.08）岁，ASAⅠ/Ⅱ级，采用随机数字表法分为4组：C组（丙泊酚组），R1组（0.5 ng/mL瑞芬太尼联合丙泊酚组），R2组（1.0 ng/mL瑞芬太尼联合丙泊酚组），R3组（1.5 ng/mL瑞芬太尼联合丙泊酚组）。采用Dixon序贯法确定各组丙泊酚EC₅₀，丙泊酚靶控输注初始血浆效应室浓度设为5 μg/mL，相邻阶梯浓度差值为1 μg/mL，进镜吞咽反射或体动，则下一患者丙泊酚浓度提升一阶梯，反之则降低一阶梯。采用Probit回归分析不同组别丙泊酚EC₅₀及95%置信区间（confidence interval，CI）；记录各组手术时长、麻醉及复苏时间、术中呛咳、呼吸和心率抑制等不良事件。结果： C、R1、R2、R3组丙泊酚EC₅₀依次为6.686、6.476、5.970、5.640 μg/mL；4组手术及麻醉时长比较差异无统计学意义（P>0.05）。苏醒时长：R1组与C组比较，差异无统计学意义（P>0.05），R2、R3组与C组比较，差异具有统计学意义（P<0.05）。置镜时心率（heart rate，HR）：R1组与C组比较，差异无统计学意义（P>0.05），R2、R3组与C组比较，差异具有统计学意义（P<0.05）。置镜时平均动脉压（mean arterial pressure，MAP）：R1组与C组比较，差异无统计学意义（P>0.05），R2、R3组与C组比较，差异具有统计学意义（P<0.05）。麻醉中呼吸抑制：R1组与C组比较，差异无统计学意义（P>0.05），R2、R3组与C组比较，差异具有统计学意义（P<0.05）。结论： 内镜下黏膜术中，瑞芬太尼靶控浓度为1.0 ng/mL时，与丙泊酚TCI配伍使用更为安全有效，患者呛咳、呼吸抑制或心动过缓的情况更少。

Abstract:

Objective: To investigate the effect of different concentrations of remifentanil on the effective concentration 50% (EC₅₀) and the anesthesia quality in patients receiving target controlled infusion (TCI) of propofol. Methods: One hundred and fifty patients who received endoscopic mucosal resection (EMR), with ASA physical statusⅠ/Ⅱand ages of (59.11±10.08) years old, were randomly divided into four groups: C group (propofol group), R1 group (0.5 ng/mL of remifentanil combined with propofol), R2 group (1.0 ng/mL of remifentanil combined with propofol) and R3 group (1.5 ng/mL of remifentanil combined with propofol). The Dixon’s sequential method was used to determine the EC₅₀of propofol concentration, with initial plasma effect-side concentration of 5.0 μg/mL via TCI and step size of 1 μg/mL. Concentration of propofol was able to be increased for next one patient when deglutition reflex or body movement in gastroscope placement for one patient, whereas the concentration was going to be decreased. The EC₅₀ and 95%confidence interval (CI) of propofol in different groups calculated by Probit regression analysis. Adverse events of operative time, anesthesia and resuscitation time, intraoperative coughing and respiratory and heart rate depression were recorded. Results: EC₅₀of propofol in C group, R1 group, R2 group and R3 group were 6.686 μg/mL, 6.476 μg/mL, 5.970 μg/mL and 5.640 μg/mL, respectively. The operation and anesthesia duration among four groups had no statistically significant differences (P>0.05). For the resuscitation time, there was no statistically significant difference between C group and R1 group (P>0.05), but there were statistically significant differences between R2 group and R3 group and C group (P<0.05). For heart rate (HR) during placing gastroscope, there was no statistically significant difference between C group and R1 group (P>0.05), but there were statistically significant differences between R2 group and R3 group and C group (P<0.05). For mean arterial pressure (MAP), there was no statistically significant difference between C group and R1 group (P>0.05), but there were statistically significant differences between R2 group and R3 group and C group (P<0.05). For respiratory depression during anesthesia, there was no statistically significant difference between C group and R1 group (P>0.05), but there were statistically significant differences between R2 group and R3 group and C group (P<0.05). Conclusion: In endoscopic mucosal resection, remifentanil concentration of 1.0 ng/mL combined with the propofol TCI is safer and more effective, without less coughing, respiratory depression or bradycardia.