文章摘要
复合环泊酚麻醉诱导时舒芬太尼抑制老年患者气管插管心血管反应的半数有效效应室浓度
Median effect-site concentration of sufentanil combined with ciprofol blunting cardiovascular responses to tracheal intubation in elderly patients
  
DOI：10.12089/jca.2024.11.008
中文关键词: 半数有效浓度  舒芬太尼  环泊酚  气管插管  老年
英文关键词: Median effect-site concentration  Sufentanil  Ciprofol  Tracheal intubation  Aged
基金项目:江苏省卫生健康委医学科研项目（M2023223）；南京市卫生科技发展专项资金项目（YKK22136）
作者单位E-mail
梅凤美 210029,南京医科大学附属脑科医院麻醉科  
赵金兵 210029,南京医科大学附属脑科医院脑血管救治中心  
金晶星 210029,南京医科大学附属脑科医院麻醉科  
陆军 210029,南京医科大学附属脑科医院麻醉科  
曾琼 210029,南京医科大学附属脑科医院麻醉科 zengqiongnju@163.com 
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中文摘要:
      
目的： 探讨并比较复合丙泊酚或环泊酚诱导时舒芬太尼抑制老年患者气管插管心血管反应的半数有效效应室浓度（Ce50）。
方法： 选择择期行气管插管全麻颅内外血运重建术的老年患者66例，男32例，女34例，年龄≥65岁，BMI 20～30 kg/m2。将患者随机分为两组：丙泊酚组（P组）和环泊酚组（C组），每组33例。两组首例患者靶控输注舒芬太尼0.30 ng/ml，达到效应室浓度后根据分组分别缓慢静脉注射丙泊酚1.5 mg/kg或环泊酚0.30 mg/kg，待患者意识消失且BIS≤60，给予罗库溴铵0.60 mg/kg，肌松完全TOF为0后行气管插管。气管插管心血管阳性反应为气管插管后2 min内HR或SBP升高幅度超过基础值的20%。舒芬太尼的靶浓度由序贯法确定，相邻浓度梯度比为1∶1.2。根据气管插管反应，上调或下降一个浓度梯度，直至第7个阳性反应-阴性反应交叉点时结束试验。记录麻醉诱导前（T0）、气管插管前（T1）、气管插管后1 min（T2）、气管插管后3 min（T3）和气管插管后5 min（T4）的HR、SBP、DBP和BIS。采用Dixon-Mood半数有效量序贯法计算公式计算Ce50及其95%可信区间（CI）。
结果： 与P组比较，C组T1时SBP明显升高；T2—T4时BIS明显降低（P<0.05）。P组和C组舒芬太尼抑制气管插管心血管反应的Ce50分别为0.253 ng/ml（95%CI 0.215～0.297 ng/ml）和0.241 ng/ml（95%CI 0.209～0.279 ng/ml），两组Ce50差异无统计学意义。
结论： 麻醉诱导复合丙泊酚1.5 mg/kg时舒芬太尼抑制老年患者气管插管心血管反应的Ce50为0.253 ng/ml（95%CI 0.215～0.297 ng/ml），复合环泊酚0.30 mg/kg时舒芬太尼抑制老年患者气管插管心血管反应的Ce50为0.241 ng/ml （95%CI 0.209～0.279 ng/ml）。
英文摘要:
      
Objective: To investigate and compare the median effect-site concentration (Ce50) of sufentanil combined with propofol or ciprofol blunting cardiovascular responses to tracheal intubation in elderly patients.
Methods: Sixty-six elderly patients were selected for extracranial-intracranial cerebral revascularization for general anesthesia with tracheal intubation, 32 males and 34 females, aged ≥ 65 years, BMI 20-30 kg/m2. Patients were randomly divided into two groups: 1.5 mg/kg propofol group (group P) and 0.3 mg/kg ciprofol group (group C), 33 patients in each group. Sufentanil was target controlled infused with the initial dose of 0.30 μg /kg, then propofol 1.5 mg/kg or ciprofol 0.30 mg/kg injected slowly after reaching the effect-site concentration. After the lose of consciousness and BIS score less than or equal to sixty, rocuronium 0.60 mg/kg was administrated, and underwent endotracheal intubation after the TOF value monitored by muscle relaxation drops to zero. Dixon's up and down sequential method was used to determine the target concentration of sufentanil. A positive response was defined as a 20% increase in HR or SBP exceeding the baseline within 2 minutes after tracheal intubation, otherwise, it was considered a negative response. According to the Dixon's sequential method, the ratio of adjacent dosed was 1.2 and if the patient had a positive response, the dose of next patient was moved up one gradient, otherwise, the dose would be reduced. The trail was terminated when the seventh crossover point was observed. When a positive response turned to a negative response, it was called a crossover point. HR, SBP, DBP and BIS were recorded before induction of anesthesia (T0), before tracheal intubation (T1), 1 minutes after tracheal intubation (T2), 3 minutes after tracheal intubation (T3) and 5 minutes after tracheal intubation (T4). Dixon-Mood's half effective quantity sequential calculation formula was used to calculate the Ce50 and 95% confidence interval (CI).
Results: Compared with group P, SBP was significantly increased at T1 , BIS was significantly decreased at T2-T4 in group C (P < 0.05). The Ce50 and 95% CI of sufentanil inhibiting cardiovascular response to tracheal intubation were 0.253 ng/ml (95% CI 0.215-0.297 ng/ml) in group P and 0.241 ng/ml (95% CI 0.209-0.279 ng/ml) in group C. There was no significant difference in Ce50 between the two groups.
Conclusion: When combined with propofol 1.5 mg/kg during anesthesia induction, the Ce50 of sufentanil inhibiting cardiovascular response to tracheal intubation in elderly patients was 0.253 ng/ml (95% CI 0.215-0.297 ng/ml). While combined with cirprofol 0.30 mg/kg, Ce50 of sufentanil was 0.241 ng/ml (95% CI 0.209-0.279 ng/ml).
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