摘要
目的评价七氟醚和依托咪酯镇静催眠效应的相互作用。方法择期全麻手术患者24例，ASAⅠ或Ⅱ级，年龄18～59岁，体重指数17—27kg／m^2。试验Ⅰ12例患者靶控输注依托咪酯，效应室靶浓度依次为0．05、0．1、0．2、0．3、0．4、0．5μg/ml。效应室浓度依次达到预设浓度2min时，记录反应熵（RE）、状态熵（SE）和警觉／镇静（OAA／S）评分，然后停止输注依托咪酯。随机分为3组（n=4），A1组、B，组、C1组吸入七氟醚，呼气末浓度分别为0．5％、1％、2％。七氟醚呼气末浓度达预定浓度的95％或以上时，靶控输注依托咪酯，效应室靶浓度依次为0．2、0．3、0．4、0．5／sg／ml。效应室浓度依次达到预设浓度2min时，记录RE、SE和OAA／S评分。试验Ⅱ12例患者吸入七氟醚，呼气末浓度依次为0．5％、1％、2％、3％、4％、5％。依次达到预定呼气末浓度时，记录RE、SE和OAA／S评分，然后停止吸入七氟醚，吸氧洗脱七氟醚。随机分为3组（n=4），A2组、B2组、C2组靶控输注依托咪酯，效应室靶浓度分别为0．05、0．1、0．2μg／ml。效应室浓度达到预设浓度2min时，吸入七氟醚，呼气末浓度依次为0．5％、1％、2％、3％、4％、5％。依次达到预定呼气末浓度时，记录RE、SE和OAA／S评分。采用反应曲面法评价RE、SE和OAA／S评分，判断七氟醚和依托咪酯镇静催眠效应的相互作用。结果RE和SE的相互作用指数的拟合值及其95％可信区间分别为0．32（-0．07—0．71）、0．25（-0．12—0．63）（P〉0．05）。OAA／S评分的相互作用指数的拟合值及其95％可信区间为2．25（0．58—3．93）（P〈0．05）。结论以脑电熵指数反映镇静催眠效应时七氟醚和依托咪酯为相加作用；以OAA／S评分反映镇静催眠效应时七氟醚和依托咪酯为协同作用。
Objective To evaluate sedative and hypnotic interactions between sevoflurane and etomidate. Methods Twenty-four ASA Ⅰ or Ⅱ patients aged 18-59 yr with body mass index 17-27 kg/m^2 undergoing elective surgery under general anesthesia were included in this study. Part Ⅰ Twelve patients received etomidate by TCI at target effect-site concentrations （Ce） of 0.05, 0.1, 0.2, 0.3, 0.4 and 0.5 μg/ml in turn. When the preset concentrations were reached for 2 min, the spectral entropy index （response entropy, RE ; state entropy, SE） and Observer＇s Assessment of Alertness/Sedation （OAA/S） score were recorded and TCI of etomidate was stopped. The patients were randomly divided into 3 groups （ n = 4 each）, inhaling sevoflurane with end-tidal concentrations of 0.5% （group A1 ）, 1% （group Bl ） and 2% （group CI ）. When the sevoflurane concentration reached 95% predetermined end-tidal concentration or more, etomidate was administered via TCI at Ce of 0.05, 0.1, 0.2, 0.3, 0.4 and 0.5 gg/ml in turn. When the preset concentrations were reached for 2 min, RE, SE and OAA/S score were recorded. Part Ⅱ Twelve patients inhaled sevoflurane with end-tidal concentrations of 0.5%, 1%, 2% , 3%, 4% and 5% in turn. When the predetermined end-tidal concentrations were reached, RE, SE and OAA/S score were recorded and inhalation of sevoflurane was stopped. Sevoflurane was washed out. Then the patients were randomly divided into 3 groups （ n = 4 each）, receiving etomidate by TCI at Ce of 0.05 μg/ml （group A2 ）, 0.1 /μg/ml （group B2 ）and 0.2 μg/ml （group C2 ） respectively. The patients inhaled sevoflurane with end-tidal concentrations of 0.5 %, 1%, 2 %, 3 %, 4 % and 5 % in turn 2 min after the preset concentrations were reached. When the predetermined end-tidal concentrations were reached, RE, SE and OAA/S score were recorded. Response surface pharmacodynamic interaction models were constructed to evaluate RE, SE and OAMS score and determine sedative and hypnotic interactions between sevoflu
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2009年第5期389-393,共5页
Chinese Journal of Anesthesiology
关键词
麻醉药
吸入
依托咪酯
药物相互作用
清醒镇静
催眠术
麻醉
Anesthetics, inhalation
Etomidate
Drug interactions
Conscious sedation
Hypnosis, anesthetic
