芬太尼抑制老年患者胸科手术全麻苏醒期躁动的半数有效剂量 张杰杰 .doc

芬太尼抑制老年患者胸科手术全麻苏醒期躁动的半数有效剂量 张杰杰 宋杰 王建(南通市第一人民医院麻醉科 江苏南通 226001) 【摘要】 目的 探讨芬太尼。方法 选择拟在全麻下行患者，年龄~77岁，体重~82kg，ASA I或II级。麻醉诱导：咪达唑仑0.05mg/kg，mg/kg，芬太尼μg/kg，阿曲库铵0.mg/kg。5内完成插管行机械通气，维持PetCO2 35~45 mmHg。随后于手术切皮前再次静脉注射芬太尼，静脉注射芬太尼的剂量采用改良序贯法确定并且术中不再追加任何镇痛药物。本研究所计算的芬太尼剂量为两次注射芬太尼剂量的总和。麻醉维持：持续泵入瑞芬太尼0.1μg·kg-1·min-1，丙泊酚~4mg·kg-1·h-1，阿曲库铵 mg·kg-1·h-1。手术结束前30停用阿曲库铵，手术结束时停用瑞芬太尼和丙泊酚。计≥2为出现麻醉苏醒期躁动。计算芬太尼抑制ED50及其95%可信区间。 结果 芬太尼抑制ED50及其95%可信区间为μg/kg和7.36~7.84μg/kg。 【关键词】 芬太尼；ED50 of fentanyl on emergence agitation during recovery period in elderly patients undergoing thoracic surgery under general anesthesia. Zhang Jie-jie, Song Jie, Wang Jiang (Department of Anesthesiology, The First People’s Hospital of Nantong, Nantong 226001, China) [Abstract] Objective To explore the median effective dose (ED50) and 95% confidence interval (CI) of fentanyl on emergence agitation during recovery period in elderly patients undergoing thoracic surgery under general anesthesia. Methods Twenty-nine ASA I or II patients aged 65-77 years weighing 48-82 kg undergoing thoracic surgery under remifentanyl intravenous combined anesthesia were studied. The patients were unpremedicated. Anesthesia was induced with iv midazolam Lun 0.05mg/kg, etomidate 0.3mg/kg, fentanyl 4μg/kg and cisatracurium besilate 0.15mg/kg. The patients were mechanical ventilated after tracheal intubation within 5 min. The patients would be one-lung ventilated discontinuously during surgeries. Then the fentanyl was injected again before cutting. The dose of fentanyl injected the second time was determined by using modified Dixon’s up-and-down method (increment or decrement of 0.5μg/kg ). Anesthesia was maintained with remifentanyl infusion at 0.1μg·kg-1·min-1 , propofol 2~4mg·kg-1·h-1 and cisatracurium besilate 0.2 mg·kg-1·h-1. The cisatracurium besilate infusion was terminated 30 min before the end of surgery. The remifentanyl and the propofol infusions were terminated at the end of surgery. The patients were transferred to the PACU. The