现代妇产科进展Issue(6)：438-440,3.DOI:10.13283/j.cnki.xdfckjz.2015.06.012
复合丙泊酚时瑞芬太尼抑制产妇气管插管反应的有效剂量
Effective dose of remifentanil inhibiting response to tracheal intubation when combined with propofol for cesarean section
摘要
Abstract
Objective:To calculate the effective dose of remifentanil inhibiting respon-ses to tracheal intubation when combined with propofol for cesarean section. Methods:This study included 32 ASA I~II full-term pregnant women with absolute or relative contraindication to spinal anesthesia who underwent cesarean section under general anesthesia. Anesthesia was induced with propofol continuous intravenous infusion. When Observerˊs Assessment of Alert-ness/Sedation(OAA/S)score≤3,remifentanil was continuous pumped,the initial dose was 0. 8μg/kg. The dosage of propofol was adjusted until the index of consciousness ( IOC) was below 70,then the endotracheal tube was intubated. The dose of remifentanil was determined by a modified Dixonˊs up-and-down method. Each time the dosage of remifentanil increased/de-creased in the next patient depending on whether or not the response to tracheal intubation. The response to tracheal intubation was defined as an increased SBP or HR by >30% at 1 min after tracheal intubation than 2 mins before induction,or development of coughing,body movement during intubation. The IOC of mothers and the Apgar score of neonates at 1 and 5 min after de-livery were recorded. The modified Brice questionnaire was performed after complete recovery from general anesthesia and at the 1sth and 5th day after surgery. The 50% effective dosage ( ED50 ) and 95% effective dosage ( ED95 ) were calculated by a probit analysis. Results:The probit analysis showed that the ED50 and ED95 of remifentanil for tracheal intubation was 1. 04μg/kg (95% confidence interval,0. 89 ~1. 1) and 1. 25μg/kg (95% confidence interval, 1. 14~2. 76),respectively. Two of 32 neonates had an Apgar score of<8 at 1 min after deliver-y,and required artificial ventilation. All neonates had an Apgar score of 10 at 5 min after deliv-ery. No patients had recall of intraoperative events. Conclusion:The ED50 and ED95 of remifen-tanil for tracheal intubation in patients with cesarean section under general anesthesia is 1 . 04μg/kg and 1. 25μg/kg. Appropriate level of anesthesia can lessen remifentanil-induced neo-natal depression without the occurrence of intraoperative awareness.关键词
瑞芬太尼/丙泊酚/气管插管/意识指数/剖宫产Key words
Cesarean/Remifentanil/Propofol/Tracheal intubation/Index of conscious-ness分类
医药卫生引用本文复制引用
张兆航,张丽,李亮,周长青,王春玲..复合丙泊酚时瑞芬太尼抑制产妇气管插管反应的有效剂量[J].现代妇产科进展,2015,(6):438-440,3.基金项目
山东省自然科学基金资助(No:ZR2010HM120) （No:ZR2010HM120）
