氟比洛芬酯对两种不同靶浓度瑞芬太尼输注下七氟醚MACBAR的影响

摘要

目的 研究氟比洛芬酯对两种不同靶控浓度瑞芬太尼(1和3 ng/mL)输注下七氟醚能抑制切皮时肾上腺素能反应的最低肺泡气浓度(MACBAR)的影响.方法 76例拟全麻行腹部手术患者随机分为4组:七氟醚+1 ng/mL瑞芬太尼(A1组);七氟醚+1 ng/mL瑞芬太尼+1 mg/kg氟比洛芬酯(F1组);七氟醚+3 ng/mL瑞芬太尼(A3组);七氟醚+3 ng/mL瑞芬太尼+1 mg/kg氟比洛芬酯(F3组).采用改良序贯法进行实验,计算各组的七氟醚MACBAR,用概率单位回归分析计算各组七氟醚的ED50和ED95.结果 A1、F1组七氟醚的MACBAR分别为2.03%[95%置信区间(95%CI):1.9%～2.1%]和1.65%(95%CI:1.5%～1.9%),F1组较A1组减少18.8%,差异有统计学意义(P<0.01);A3、F3组七氟醚的MACBAR分别为0.4%(95%CI:0.2%～0.6%)和0.35%(95%CI:0.2%～0.4%),F3组较A3组减少12.5%,但差异无统计学意义(P>0.05).结论 瑞芬太尼效应室浓度1 ng/mL靶控输注下,氟比洛芬酯可减低七氟醚MACBAR的18.8%;效应室浓度3 ng/mL靶控输注下,其可减低七氟醚MACBAR的12.5%.%Objective To determine the effects of flurbiprofen axetil on the sevoflurane requirement for blunting adrenergic responses following surgical incision when sevoflurane combined with two different target-controlled concentrations of remifentanil (1 and 3 ng/mL). Methods A total of 76 patients, scheduled to undergoing general anaesthesia for elective abdominal surgery, were randomly allocated to receive sevoflurane anaesthesia alone (group A,n = 41),or with the addition of flurbiprofen (group F,n = 35). Patients of both groups were further assigned to receive a target-controlled effect-site concentration of 1 ng/mL (group A1, n = 24;group Fl,n = 21),or 3 ng/mL remifentanil (group A3 ,n = 17 ;group F3,n=14). Predetermined end-tidal sevoflurane con-centrations and minimum alveolar concentration (MAC) for each group were determined using an up-and-down sequential allocation technique. Results All patients completed the study. The MAC of sevoflurane were 2. 03% [95% confidence interval(95%CD : 1. 9%-2. 1%] in group Al and 1. 65%(95%CI:1. 5%- 1. 9%)in group F1 (P<0. 01) , group F1 reduced it by 18. 8% than group A1;while in groups A3 and F3 the MAC of sevoflurane were 0. 4%(95%CI:0. 2%-0. 6%)and 0. 35%(95%CI:0. 2%-0. 4%) , respectively (P>0. 05) ,group P3 reduces by 12. 5%. Conclusion The addition of flurbiprofen axetil reduces the MAC of sevoflurane by 18. 8% when using a remifentanil concentration of 1 ng/mL,and reduces 12. 5% when using a remifentanil concentration of 3 ng/mL.