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| 联合舒芬太尼时瑞马唑仑抑制气管插管心血管反应的半数有效剂量 |
| Median effective dose of remimazolam required to prevent cardiovascular response to tracheal intubation when combined with sufentanil |
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| DOI：10.12089/jca.2021.10.005 |
| 中文关键词: 气管插管 瑞马唑仑 量-效关系 药效学 半数有效剂量 |
| 英文关键词: Intubation Remimazolam Dose-response relationship Pharmacodynamics Median effective dose |
| 基金项目:河南省医学科技攻关计划（联合共建）项目（LHGJ20190665）；河南省医学科技攻关计划项目（LHGJ20200184） |
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| 中文摘要: |
目的 评价联合舒芬太尼时瑞马唑仑抑制气管插管心血管反应的半数有效剂量（ED50）。
方法 选择全身麻醉置入单腔气管导管手术患者49例，男29例，女20例，年龄18～64岁，BMI 20～25 kg/m2，ASA Ⅰ或Ⅱ级。首例患者给予瑞马唑仑0.20 mg/kg，待患者意识消失，警觉/镇静评分（OAA/S评分）≤1分且BIS≤60后，给予舒芬太尼0.25 μg/kg，根据上一例患者气管插管心血管反应情况，采用抛偏倚硬币法决定下一例瑞马唑仑剂量。若上一例气管插管心血管反应为阳性，下一例患者瑞马唑仑升高1个剂量梯度；若上一例气管插管心血管反应为阴性，则下一例随机有11%的概率降低瑞马唑仑1个剂量梯度，有89%的概率维持上一例的剂量梯度。设定瑞马唑仑相邻剂量差值为0.01 mg/kg。计算瑞马唑仑抑制气管插管心血管反应的ED50、95%有效剂量（ED95）及其95%可信区间（CI）。
结果 瑞马唑仑抑制气管插管心血管反应的ED50为0.190 mg/kg（95%CI 0.131～0.194 mg/kg），ED95为0.202 mg/kg（95%CI 0.198～0.220 mg/kg）。
结论 联合舒芬太尼0.25 μg/kg时，瑞马唑仑抑制气管插管心血管反应的ED50为0.190 mg/kg（95%CI 0.131～0.194 mg/kg）。 |
| 英文摘要: |
Objective To evaluate the median effective dose (ED50) of remimazolam required to prevent cardiovascular response to tracheal intubation when combined with sufentanil.
Methods Forty-nine patients with tracheal intubation under general anesthesia, 29 males and 20 females, aged 18-64 years, BMI 20-25 kg/m2, ASA physical status Ⅰ or Ⅱ, were selected in this study. The first patient was given remimazolam 0.20 mg/kg, after the patient's consciousness disappeared, observer's assessment of alertness / sedation (OAA/S) score ≤ 1 and BIS ≤ 60, sufentanil 0.25 μg/kg was given. The dose of remimazolam for the next patient was determined by using the biased coin design method and based on the situation of tracheal tube insertion in the previous patient. If the cardiovascular response of the previous patient was positive after endotracheal intubation, the dose gradient of remimazolam was increased one dose gradient in the next patient. If the cardioascular response was negative in the previous patient, the next patient had an 11% chance of reducing one dose gradient of remimazolam and an 89% chance of maintaining the previous dose gradient. The adjacent dose of remimazolam was set as 0.01 mg/kg. According to the observation results, the ED50 and ED95 with corresponding 95% confidence interval (CI) of remimazolam required to prevent cardiovascular response to tracheal intubation were analyzed and calculated.
Results The ED50 and ED95 of remimazolam required to prevent cardiovascular response to tracheal intubation were 0.190 mg/kg (95% CI 0.131-0.194 mg/kg) and 0.202 mg/kg (95% CI 0.198-0.220 mg/kg), respectively.
Conclusion The ED50 of remimazolam required to prevent cardiovascular response to tracheal intubation is 0.190 mg/kg (95% CI 0.131-0.194 mg/kg) when combined with sufentanil 0.25 μg/kg. |
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