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中华疝和腹壁外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (01) : 51 -53. doi: 10.3877/cma.j.issn.1674-392X.2019.01.014

所属专题: 文献

论著

全麻下抑制小儿疝修补术体动反应的瑞芬太尼效应室浓度探讨
赵三军1,(), 张宏强2, 肖剑锐3, 陆东东4, 程庆春1   
  1. 1. 071000 河北保定,解放军第82集团军医院麻醉科
    2. 071000 河北保定,解放军第82集团军医院耳鼻喉科
    3. 071000 河北保定,解放军第82集团军医院口腔科
    4. 714000 陕西渭南,32144部队卫生连
  • 收稿日期:2018-06-01 出版日期:2019-02-18
  • 通信作者: 赵三军

Study on effect chamber concentration of remifentanil inhibiting the body motion response of children undergoing hernia repair under general anesthesia

Sanjun Zhao1,(), Hongqiang Zhang2, Jianrui Xiao3, Dongdong Lu4, Qingchun Cheng1   

  1. 1. Department of Anesthesiology, the 82nd Group Military Hospital of PLA, Baoding 071000, China
    2. ENT, the 82nd Group Military Hospital of PLA, Baoding 071000, China
    3. Stomatology, the 82nd Group Military Hospital of PLA, Baoding 071000, China
    4. Health company of 32144 troops, Weinan 714000, China
  • Received:2018-06-01 Published:2019-02-18
  • Corresponding author: Sanjun Zhao
  • About author:
    Corresponding author: Ultrastructural, Email:
引用本文:

赵三军, 张宏强, 肖剑锐, 陆东东, 程庆春. 全麻下抑制小儿疝修补术体动反应的瑞芬太尼效应室浓度探讨[J/OL]. 中华疝和腹壁外科杂志(电子版), 2019, 13(01): 51-53.

Sanjun Zhao, Hongqiang Zhang, Jianrui Xiao, Dongdong Lu, Qingchun Cheng. Study on effect chamber concentration of remifentanil inhibiting the body motion response of children undergoing hernia repair under general anesthesia[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2019, 13(01): 51-53.

目的

探讨小儿疝修补术患者非肌松条件下使用瑞芬太尼抑制术中体动反应的有效效应室浓度。

方法

选择2017年1月至2018年2月,解放军第82集团军医院择期行疝修补术的患儿28例(年龄<12岁),ASA分级Ⅰ或Ⅱ级。麻醉诱导和维持采用丙泊酚(Marsh模型)和瑞芬太尼(Minto模型),BIS控制在45~55。初始瑞芬太尼效应室浓度为4.0 ng/ml,根据患儿术中有无出现阳性反应(无体动反应)和Dixon up-and-down方法调节下一例患儿瑞芬太尼效应室靶浓度,调节幅度为0.2 ng/ml。经历7次阳性-阴性反应交叉,并根据阴性-阳性反应配对的平均值和probit回归计算EC50、EC95(effective concentration)。

结果

瑞芬太尼抑制小儿疝修补术中体动的效应室浓度为3.99 ng/ml,经probit回归分析,EC50和EC95为3.90 ng/ml和4.34 ng/ml。

结论

无肌松条件下实施小儿疝修补术时,瑞芬太尼效应室浓度达到3.90 ng/ml和4.34 ng/ml时,分别有50%和95%可能性抑制患儿的体动反应。

Objective

To investigate the effective concentration of remifentanil inhibiting the body movement in children undergoing hernia repair with no muscle relaxation.

Methods

From January 2017 to February 2018, twenty-eight children (age<12 years old) underwent selective hernia repair and ASA grade I or II in the 82nd Group Military Hospital of PLA were enrolled. Anesthesia induction and maintenance were performed with propofol (Marsh model) and remifentanil (Minto model). BIS was controlled ranging from 45 to 55. The initial effect chamber concentration of remifentanil was 4.0 ng/ml and the next patient's target effect chamber concentration of remifentanil was adjusted according to the positive reaction (no body motion response) in the former child and Dixon up-and-down method, with an adjustment range of 0.2 ng/ml. After seven negative-positive reaction crossovers, the EC50 and EC95 (effective concentration) were calculated based on the mean of the negative-positive reaction pair and Probit regression.

Results

The EC50 of remifentanil in the inhibition of body movement in children undergoing hernia repair was 3.99 ng/ml. The EC50 and EC95 were 3.90 ng/ml and 4.34 ng/ml, respectively, by Probit regression analysis.

Conclusion

The EC50 and EC95 of the effect chambers inhibiting the body motion of children undergoing hernia repair were 3.90 ng/ml and 4.34 ng/ml.

图1 不同瑞芬太尼效应室浓度下的序贯实验,其中箭头所示为每一个阴性-阳性反应配对的平均值
图2 不同瑞芬太尼效应室浓度下发生阳性反应(无体动)的概率
[1]
Tulgar S, Boga I, Cakiroglu B, et al. Short-lasting pediatric laparoscopic surgery: Are muscle relaxants necessary? Endotracheal intubation vs. laryngeal mask airway[J]. J Pediatr Surg, 2017, 52(11): 1705-1710.
[2]
Ahiskalioglu A, Ince I, Ahiskalioglu E O, et al. Is Neuromuscular Blocker Necessary in Pediatric Patients Undergoing Laparoscopic Inguinal Hernia Repair with Percutaneous Internal Ring Suturing?[J]. Eur J Pediatr Surg, 2017, 27(3): 263-268.
[3]
Kim M K, Lee J W, Jang D J, et al. Effect-site concentration of remifentanil for laryngeal mask airway insertion during target- controlled infusion of propofol[J]. Anaesthesia, 2009, 64(2): 136-140.
[4]
Dixon WJ. Staircase bioassay: the up-and-down method[J]. Neurosci Biobehav Rev, 1991, 15(1): 47-50.
[5]
Campanelli G, Bruni PG, Morlacchi A, et al. Primary inguinal hernia: The open repair today pros and cons[J]. Asian J Endosc Surg, 2017, 10(3): 236-243.
[6]
Soderstrom CM, Borregaard Medici R, Assadzadeh S, et al. Deep neuromuscular blockade and surgical conditions during laparoscopic ventral hernia repair: A randomised, blinded study[J]. Eur J Anaesthesiol, 2018, 35(11): 876-882.
[7]
Kamata M, Tobias JD. Remifentanil: applications in neonates[J]. J Anesth, 2016, 30(3): 449-460.
[8]
Fuentes R, Cortinez LI, Contreras V, et al. Propofol pharmacokinetic and pharmacodynamic profile and its electroencephalographic interaction with remifentanil in children[J]. Paediatr Anaesth, 2018, 28(12): 1078-1086.
[9]
Palumbo P, Usai S, Amatucci C, et al. Inguinal hernia repair in day surgery: the role of MAC(Monitored Anesthesia Care) with remifentanil[J]. G Chir, 2017, 38(6): 273-279.
[10]
Chen BZ, Chu QJ, Yu J R, et al. The effect of remifentanil on the minimum alveolar concentration of isoflurane in children[J]. J Clin Anesth, 2015, 27(6): 504-507.
[11]
Choi SC. Interval estimation of the LD50 based on an up-and-down experiment[J]. Biometrics, 1990, 46(2): 485-492.
[12]
Han JU, Cho S, Jeon WJ, et al. The optimal effect-site concentration of remifentanil for lightwand tracheal intubation during propofol induction without muscle relaxation[J]. J Clin Anesth, 2011, 23(5): 379-383.
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