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| 复合瑞芬太尼时瑞马唑仑用于老年患者全膝关节置换术全麻镇静的半数有效剂量 |
| Median effective dose of remimazolam combined with remifentanil for general anesthesia sedation in elderly patients undergoing total knee arthroplasty |
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| DOI：10.12089/jca.2023.01.008 |
| 中文关键词: 瑞马唑仑 瑞芬太尼 股神经阻滞 全膝关节置换术 半数有效剂量 |
| 英文关键词: Remimazolam Remifentanil Femoral nerve block Total knee arthroplasty Median effective dose |
| 基金项目: |
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| 中文摘要: |
目的 采用序贯法测定复合瑞芬太尼时瑞马唑仑用于老年患者全膝关节置换术全麻镇静的半数有效剂量（ED50）。
方法 选择择期行单膝全膝关节置换术老年患者29例，男13例，女16例，年龄≥65岁，BMI＜30 kg/m2，ASAⅠ—Ⅲ级。麻醉诱导后行超声引导下股神经阻滞，麻醉维持采用瑞芬太尼0.05～0.20 μg·kg-1·min-1，顺式阿曲库铵0.1 mg·kg-1·h-1和瑞马唑仑。根据预试验确定瑞马唑仑的起始剂量为0.7 μg·kg-1·min-1，相邻浓度比值为1∶1.15，以出现镇静无效的前一例患者为第1例，按照序贯法确定下一例瑞马唑仑的维持剂量，若上一例镇静有效（BIS≤60、MAP波动幅度<基础值的20%且术后随访无术中知晓），则下一例在上一例的给药剂量基础上降低一个梯度，反之任意一项指标不达标则为镇静无效，下一例给药剂量升高一个梯度，重复此过程直到出现第7个拐点终止研究。采用概率单位Probit回归分析法计算瑞马唑仑的ED50和ED95及其95％可信区间（CI）。记录术中知晓、心动过缓、恶心呕吐等不良反应的发生情况。
结果 瑞马唑仑复合瑞芬太尼联合神经阻滞用于老年全膝关节置换术全麻镇静的ED50为0.539 μg·kg-1·min-1（95%CI 0.469～0.604 μg·kg-1·min-1），ED95为0.681 μg·kg-1·min-1（95%CI 0.611～1.136 μg·kg-1·min-1）。1例术中出现窦性心动过缓，给予阿托品有效，1例术后4 h出现恶心呕吐，无一例发生术中知晓和其他不良反应。
结论 复合瑞芬太尼时瑞马唑仑用于老年患者全膝关节置换术全麻镇静的ED50为0.539 μg·kg-1·min-1。 |
| 英文摘要: |
Objective To determine the median effective dose (ED50) of remimazolam combined with remifentanil for general anesthesia sedation in elderly patients undergoing total knee arthroplasty by sequential method.
Methods Twenty-nine elderly patients undergoing unilater total knee arthroplasty were selected, 13 males and 16 females, aged ≥ 65 years, BMI < 30 kg/m2, ASA physical status Ⅰ-Ⅲ. After induction of general anesthesia, ultrasound-guided femoral nerve block was performed, and remifentanil 0.05-0.20 μg·kg-1·min-1 and cis-atracurium 0.1 μg·kg-1·min-1 were used for general anesthesia maintenance. The initial dose of remimazolam was determined to be 0.7 μg·kg-1·min-1 according to the preliminary test, and the adjacent concentration ratio was 1∶1.15, and the previous patient with ineffective sedation was taken as the first case, the sequential method was used to determine the maintenance dose of remimazolam for the next patient,if sedation was effective in the previous patient (BIS ≤ 60, MAP fluctuation amplitude < 20% of the baseline value and no intraoperative awareness), the next patient decreased a gradient from the dose of the previous patient, otherwise, if the sedation was ineffective, and the dose of the next patient would increase by a gradient. This process was repeated until the seventh inflection point is reached to terminate the study. ED50 and ED95 of remimazolam and the respective 95% confidence interval (CI) were calculated according to the regression analysis of the Probit model. The occurrence of bradycardia, nausea and vomiting, intraoperative awareness and other adverse reactions were recorded.
Results The ED50 of remimazolam combined with remifentanil combined with nerve block was 0.539 μg·kg-1·min-1 (95% CI 0.469-0.604 μg·kg-1·min-1) for sedation of general anesthesia in senile total knee replacement, and ED95 was 0.681 μg·kg-1·min-1(95% CI 0.611-1.136 μg·kg-1·min-1). One patient had sinus bradycardia during the operation, and atropine was effective. One patient had nausea and vomiting 4 hours after operation, none of the 29 patients had any intraoperative awareness, and the patients had no obvious adverse reactions to anesthetic drugs.
Conclusion The ED50 of remimazolam combined with remifentanil combined was 0.539 μg·kg-1·min-1 for the sedation of general anesthesia in elderly patients undergoing total knee arthroplasty. |
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