本文選題：麻醉 + 瑞芬太尼��； 參考：《臨床麻醉學(xué)雜志》2017年06期

【摘要】：目的評(píng)價(jià)丙泊酚復(fù)合瑞芬太尼用于經(jīng)陰道取卵術(shù)麻醉的臨床效果,根據(jù)給藥時(shí)間、劑量和藥代動(dòng)力學(xué)模型,用計(jì)算機(jī)模擬藥物濃度,建立并分析藥效學(xué)模型及其特點(diǎn)。方法靜脈麻醉下行經(jīng)陰道取卵術(shù)患者42例,ASAⅠ或Ⅱ級(jí),隨機(jī)分為兩組,分別靜脈注射瑞芬太尼1.5μg/kg+丙泊酚1.5mg/kg(PR15組,n=24)或瑞芬太尼1.0μg/kg+丙泊酚1.0 mg/kg(PR10組,n=18)。根據(jù)患者體動(dòng)反應(yīng)和自訴疼痛情況,酌情追加瑞芬太尼0.5μg/kg和/或丙泊酚0.5 mg/kg。麻醉質(zhì)量評(píng)價(jià)主要指標(biāo)包括睫毛反射消失時(shí)間、定向力恢復(fù)時(shí)間、低氧發(fā)生率(SpO_292%)及其他不良反應(yīng)。基于模擬濃度、非線性混合效應(yīng)模型、采用NONMEM軟件建立藥效學(xué)模型。結(jié)果PR15組患者定向力恢復(fù)時(shí)間明顯慢于PR10組[(4.9±1.3)min vs(3.6±1.2)min,P0.05];但兩組睫毛反射消失時(shí)間[(58±14)s vs(64±13)s]、低氧(12.5%vs 16.7%)和咳嗽(16.7%vs11.1%)發(fā)生率差異無統(tǒng)計(jì)學(xué)意義。50%患者有效鎮(zhèn)靜的丙泊酚濃度和有效鎮(zhèn)痛的瑞芬太尼濃度(EC_(50))分別是1.71μg/ml、2.57ng/ml;95%患者有效鎮(zhèn)靜的丙泊酚濃度和有效鎮(zhèn)痛的瑞芬太尼濃度(EC_(95))分別為4.30μg/ml、4.57ng/ml。丙泊酚1.0 mg/kg產(chǎn)生的峰效應(yīng)位濃度低于EC_(50),而1.5mg/kg產(chǎn)生的峰效應(yīng)位則高于EC_(50);但瑞芬太尼1.0、1.5μg/kg產(chǎn)生的峰效應(yīng)位濃度均高于EC_(50),后者接近EC_(95)。結(jié)論基于患者恢復(fù)時(shí)間,經(jīng)陰道取卵術(shù)麻醉時(shí)瑞芬太尼1.0μg/kg復(fù)合丙泊酚1.0mg/kg較為合適。
[Abstract]:Objective to evaluate the clinical effect of propofol combined with remifentanil in anaesthesia of transvaginal oocyte extraction. According to the model of administration time, dose and pharmacokinetics, the pharmacodynamics model and its characteristics were established and analyzed by computer simulation of the concentration of propofol and remifentanil. Methods Forty-two patients with transvaginal oocyte extraction were randomly divided into two groups: intravenous remifentanil 1.5 渭 g/kg propofol 1.5mg/kg(PR15 group (n = 24) or remifentanil 1.0 渭 g/kg propofol group (n = 20) or remifentanil 1.0 渭 g/kg propofol group (n = 18). Remifentanil 0.5 渭 g/kg and / or propofol 0.5 mg / kg were added according to the patient's body movement and private pain. The main indexes of anaesthesia quality evaluation included the disappearance time of mascara reflex, the recovery time of directional force, the incidence of hypoxia, SpO292) and other adverse reactions. Based on the model of simulated concentration and nonlinear mixing effect, the pharmacodynamics model was established by NONMEM software. Results the recovery time of orientation in PR15 group was significantly slower than that in PR10 group [4.9 鹵1.3)min vs(3.6 鹵1.2 min P0.05], but there was no significant difference in the incidence of effective propofol concentration and effective propofol concentration between the two groups [58 鹵14s vs(64 鹵13s, 12.5% vs 16.7 vs 16.7i] and cough group (16.7vs 11.1g). The effective sedative concentration of propofol and the effective analgesic concentration of remifentanil in 95% patients were 4.30 渭 g / ml / ml and 4.57 ng / ml / ml, respectively. The peak effect site concentration of propofol 1.0 mg/kg was lower than that of mg/kg, while the peak effect level of 1.5mg/kg was higher than that of ECS, but the peak effect level of remifentanil 1.0 渭 g/kg was higher than that of ECS. Conclusion based on the recovery time, remifentanil 1.0 渭 g/kg combined with propofol 1.0mg/kg is more suitable for vaginal oocyte extraction anesthesia.
【作者單位】： 新疆石河子大學(xué)醫(yī)學(xué)院第一附屬醫(yī)院麻醉科;上海交通大學(xué)醫(yī)學(xué)院附屬仁濟(jì)醫(yī)院麻醉科;新疆生產(chǎn)建設(shè)兵團(tuán)醫(yī)院麻醉科;
【分類號(hào)】：R614

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