年龄对丙泊酚复合依托咪酯麻醉诱导下罗库溴铵半数有效剂量的影响

Effect of age on median effective dose of rocuronium on tracheal intubation following anesthesia of propofol combined with etomidate

  • 摘要:
      目的  探讨年龄对丙泊酚复合依托咪酯麻醉诱导下罗库溴铵半数有效剂量(ED50)的影响。
      方法   选取择期行全身麻醉颌面外科手术的160例患者作为研究对象,根据年龄的不同分为A组51例(年龄18~40岁)、B组54例(年龄41~65岁)和C组55例(年龄66~79岁)。3组均采用序贯法给予罗库溴铵, A组、B组、C组起始剂量分别为0.348、0.290、0.242 mg/kg。观察并比较3组患者麻醉诱导前(T0时点)、气管插管即刻(T1时点)、插管后1 min(T2时点)、插管后3 min(T3时点)和拔除插管即刻(T4时点)的心率(HR)、血氧饱和度(SpO2)、平均动脉压(MAP), 比较3组气管插管条件、诱导时间、起效时间、苏醒时间、苏醒后疼痛评分和不良反应,并计算罗库溴铵ED50和95%可信区间(95%CI)。
      结果   3组患者气管插管条件比较,差异无统计学意义(P > 0.05)。3组患者同一时点的HR、SpO2比较,差异无统计学意义(P > 0.05); B组、C组的MAP高于同一时点A组,差异有统计学意义(P < 0.05)。C组诱导时间、起效时间均短于A组、B组,苏醒时间长于A组、B组,差异有统计学意义(P < 0.05); A组诱导时间、起效时间、苏醒时间与B组比较,差异无统计学意义(P > 0.05)。3组患者苏醒后疼痛程度分级比较,差异无统计学意义(P > 0.05)。C组的ED50为0.267 mg/kg(95%CI为0.223~0.320), 分别低于A组、B组的0.321 mg/kg(95%CI为0.297~0.347)、0.314 mg/kg(95%CI为0.283~0.348), 差异有统计学意义(P < 0.05); A组、B组ED50比较,差异无统计学意义(P > 0.05)。3组患者术前、术中和术后不良反应发生率比较,差异无统计学意义(P > 0.05)。
      结论  年龄是丙泊酚复合依托咪酯诱导麻醉时影响罗库溴铵ED50的重要因素, 18~40岁、41~65岁和66~79岁患者的罗库溴铵气管插管ED50分别为0.321、0.314和0.267 mg/kg。

     

    Abstract:
      Objective  To investigate the effect of age on median effective dose(ED50)of rocuronium on tracheal intubation following anesthesia of propofol combined with etomidate.
      Methods  A total of 160 patients with elective operation under general anesthesia were selected as study objects, and were divided into group A(n=51, aged from 18 to 40 years), groups B(n=54, aged from 41 to 65 years) and group C(n=55, aged from 66 to 79 years) according different ages. The sequential method was conducted in three groups, with initial dosages of 0.348 mg/kg in the group A, 0.290 mg/kg in the group B and 0.242 mg/kg in the group C. The heart rate (HR), blood oxygen saturation (SpO2), mean arterial pressure (MAP) at the time points of induced anesthesia (T0), intubation (T1), 1 min after intubation (T2), 3 min after intubation (T3) and extubation (T4) were compared, tracheal intubation condition, induction time, onset time, and awakening time, pain scores and adverse reactions were recorded. Rocuronium ED50 and 95% confidence interval (95%CI) were calculated.
      Results  There was no difference in tracheal intubation condition of three groups(P > 0.05). There were no differences in heart rate (HR) and SpO2 of three groups at each time point(P > 0.05), while the levels of MAP of the group B and group C were higher than the group A at each time point(P < 0.05). Compared with the group A and the group B, the induction and onset time of the group C was shorter, while the recovery time was longer(P < 0.05). There were no significant differences in induction time, onset time and recovery time between the group A and the group B (P > 0.05). There was no statistical significance in the grading of pain degree after awakening among three groups (P > 0.05). The ED50 of the group C was 0.267 mg/kg (95%CI, 0.223 to 0.320), which was significantly lower than 0.321 mg/kg (95%CI, 0.297 to 0.347) and 0.314 mg/kg (95%CI, 0.283 to 0.348) of the groups A and B(P < 0.05). There was no significant difference in ED50 between the group A and the group B (P > 0.05). There were no significant difference of incidence of preoperative, intraoperative and postoperative adverse reactions of three groups (P > 0.05).
      Conclusion  Age is an important interfering factor on ED50 of rocuronium on tracheal intubation following anesthesia of propofol combined with etomidate, the values of ED50 for patients aged 18 to 40, 41 to 65 and 66 to 79 years are 0.321 mg/kg, 0.314 mg/kg and 0.267 mg/kg, respectively.

     

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