文章摘要
不同剂量瑞马唑仑麻醉诱导对瑞芬太尼抑制气管插管反应的半数有效血浆靶浓度的影响
Effect of different doses of remimazolam on the median effective plasma target concentration of remifentanil in inhibiting response to endotracheal intubation
  
DOI：10.12089/jca.2022.12.009
中文关键词: 瑞马唑仑  瑞芬太尼  靶控输注  半数有效血浆靶浓度
英文关键词: Remimazolam  Remifentanil  Target-controlled infusion  Median effective target plasma concentration
基金项目:贵州省教育厅青年科技人才成长项目（黔教合KY字〔2022〕237号）
作者单位E-mail
崔家田 550004,贵阳市,贵州医科大学麻醉学院  
杨扬 贵州医科大学附属医院麻醉科  
邱丽 贵州医科大学附属医院麻醉科  
曾祥刚 贵州医科大学附属医院麻醉科  
邹小华 贵州医科大学附属医院麻醉科  
陈觅 贵州医科大学附属医院麻醉科 147459443@qq.com 
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中文摘要:
      
目的 探讨麻醉诱导时不同剂量瑞马唑仑对瑞芬太尼抑制气管插管反应半数有效血浆靶浓度（Cp50）的影响。
方法 选择择期行气管插管全身麻醉手术患者79例，男14例，女65例，年龄18～60岁，BMI 18～30 kg/m2，ASAⅠ或Ⅱ级。采用随机数字法将患者分为三组：瑞马唑仑0.2 mg/kg（R1组）、0.3 mg/kg（R2组）和0.4 mg/kg（R3组）。根据分组分别静脉注射瑞马唑仑0.2、0.3、0.4 mg/kg进行麻醉诱导，待患者MOAA/S评分为0分时，将瑞芬太尼进行靶控输注（TCI）给药，3 min后行气管插管术。瑞芬太尼血浆靶浓度由序贯法确定，初始剂量为3.0 ng/ml，剂量梯度为0.2 ng/ml，并根据插管反应确定下一例患者瑞芬太尼剂量。记录入室后安静状态下、麻醉诱导后、气管插管后的HR、MAP、BIS。记录意识消失时间。采用Probit法计算Cp50及95%可信区间（CI）。
结果 与入室后安静状态下比较，麻醉诱导后R1组HR明显增快、BIS明显降低（P<0.05），R2、R3组HR明显增快，MAP、BIS明显降低（P<0.05）。与R1组比较，R2、R3组意识消失时间明显缩短（P<0.05）。与R2组比较，R3组意识消失时间明显缩短（P<0.05）。R1、R2和R3组瑞芬太尼Cp50和95%CI分别为4.23 ng/ml（95%CI 3.91～4.69 ng/ml）、3.55 ng/ml（95%CI 3.25～3.90 ng/ml）、3.42 ng/ml（95%CI 3.13～3.77 ng/ml）。与R1组比较，R2、R3组Cp50明显降低（P<0.05）。
结论 瑞芬太尼抑制气管插管反应的Cp50随着瑞马唑仑剂量的升高而降低。
英文摘要:
      
Objective To investigate the effect of different doses of remimazolam on the median effective plasma target concentration (Cp50) of remifentanil in inhibiting response to endotracheal intubation.
Methods Seventy-nine patients underwent endotracheal intubation under general anesthesia, 14 males and 65 females, aged 18-60 years, BMI 18-30 kg/m2, ASA physical status Ⅰ or Ⅱ, were randomly divided into three groups: remimazolam 0.2 mg/kg group (group R1), remimazolam 0.3 mg/kg group (group R2), remimazolam 0.4 mg/kg group (group R3). The patients received anesthesia induced by intravenous injection of remimazolam 0.2, 0.3, and 0.4 mg/kg in groups R1, R2, and R3. When the MOAA/S score was 0, remifentanil was administered by TCI, and tracheal intubation is performed 3 minutes later. Dixon's up-and-down sequential method was used to determine the plasma target concentration of remifentanil, with an initial concentration of 3.0 ng/ml and a concentration gradient of 0.2 ng/ml. The concentration of remifentanil in the next patient was determined according to whether responses to endotracheal intubation occurred. HR, MAP, and BIS were recorded in the quiet state after entering the operating room, after induction of anesthesia and after endotracheal intubation. The time of loss of consciousness was recorded. Cp50 and 95% confidence interval (CI) were calculated by Probit method.
Results Compared with the quiet state after entering the operating room, HR was increased significantly and BIS was decreased significantly after anesthesia induction in group R1 (P < 0.05), and HR was increased significantly and MAP, BIS were decreased significantly after anesthesia induction in groups R2 and R3 (P < 0.05). Compared with group R1, the time of loss of consciousness was shorter in groups R2 and R3 (P < 0.05). Compared with group R2, the time of loss of consciousness was shorter significantly in group R3 (P < 0.05). The Cp50 and 95% CI of remifentanil were 4.23 ng/ml (95% CI 3.91-4.69 ng/ml), 3.55 ng/ml (95% CI 3.25-3.90 ng/ml) and 3.42 ng/ml (95% CI 3.13-3.77 ng/ml) in groups R1, R2 and R3 respectively. Compared with group R1, Cp50 of remifentanil were significantly lower in groups R2 and R3 (P<0.05).
Conclusion The Cp50 of remifentanil inhibiting endotracheal intubation response decreased with the increase of the dose of remimazolam.
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