实用老年医学

实用老年医学 ›› 2022, Vol. 36 ›› Issue (12): 1251-1254.doi: 10.3969/j.issn.1003-9198.2022.12.016

• 临床研究 • 上一篇    下一篇

瑞芬太尼抑制老年病人经皮椎体后凸成形术中疼痛反应的半数有效浓度及95%有效浓度

阮姗, 陈霞, 杨雯, 张鹏, 桂波, 渠磊秋   

  1. 210024 江苏省南京市,江苏省省级机关医院麻醉科(阮姗,陈霞,杨雯,桂波,渠磊秋);骨科(张鹏)
  • 收稿日期:2022-04-13 出版日期:2022-12-20 发布日期:2022-11-30
  • 通讯作者: 渠磊秋,Email: 1728652516@qq.com
  • 基金资助:
    南京医科大学科技发展基金资助项目(NMUB20210173)

Median effective concentration and 95% effective concentration of remifentanil inhibiting pain response in elderly patients undergoing percutaneous kyphoplasty

RUAN Shan, CHEN Xia, YANG Wen, ZHANG Peng, GUI Bo, QU Lei-qiu   

  1. RUAN Shan, CHEN Xia, YANG Wen, GUI Bo, QU Lei-qiu. Department of Anesthesiology; ZHANG Peng. Department of Orthopedics, Jiangsu Province Official Hospital, Nanjing 210024, China
  • Received:2022-04-13 Online:2022-12-20 Published:2022-11-30

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摘要： 目的 探讨老年病人行经皮椎体后凸成形术(PKP)过程中,瑞芬太尼抑制因球囊扩张引发的疼痛反应的半数有效浓度(EC50)及95%有效浓度(EC95)。 方法 监护麻醉(MAC)下择期PKP病人按手术先后顺序依次进入序贯试验。手术开始前5 min开始靶控输注(TCI)瑞芬太尼,骨水泥开始注入时停止TCI。首例病人瑞芬太尼血浆靶控浓度设置为1.44 ng/mL,相邻靶浓度之比定为1.2。病人在接受椎体球囊扩张操作时,疼痛数字评价量表(NRS )>3分为阳性反应,反之则为阴性反应。出现阳性反应时下一例病人升高一个浓度梯度,反之则降低一个浓度梯度,出现6个阳性到阴性交叉点为止。应用Probit概率分析法计算瑞芬太尼有效抑制老年病人PKP术中椎体球囊扩张引发疼痛反应的EC50、EC95。 结果 共纳入老年病人20例, 美国麻醉医师协会(ASA) 分级Ⅰ~Ⅲ级。瑞芬太尼TCI显著降低老年病人PKP术中各时点NRS评分(P<0.05)。按照Probit概率分析法,瑞芬太尼抑制老年病人PKP术中球囊扩张引发疼痛反应的EC50为0.950 ng/mL(95%CI:0.768~1.103 ng/mL), EC95为1.179 ng/mL(95%CI:1.049~4.595 ng/mL)。 结论 瑞芬太尼TCI可有效抑制老年病人PKP术中球囊扩张引发的疼痛反应。抑制该疼痛反应的瑞芬太尼血浆靶控EC50为0.950 ng/mL,EC95为1.179 ng/mL。

关键词: 瑞芬太尼, 经皮椎体后凸成形术, 靶控输注, 半数有效浓度, 95%有效浓度

Abstract: Objective To explore the median effective concentration (EC50) and 95% effective concentration (EC95) of remifentanil inhibiting balloon dilation-induced pain response in the elderly patients undergoing percutaneous kyphoplasty (PKP). Methods The patients scheduled for selective PKP under monitored anesthesia care (MAC) were sequentially enrolled in this trial. Target-controlled infusion (TCI) of remifentanil was performed from 5 min before surgery to time-point of bone cement implantation. The plasma concentration of remifentanil was set at 1.44 ng/mL in the first patient, and the ratio of adjacent target concentrations was 1.2. When the patients were treated with balloon dilatation,the score of Numerical Rating Scale(NRS)>3 was regarded as positive reaction. When a positive reaction occurred, the next patient will be treated with an increased concentration gradient. And if a negative reaction occurred, the next patient will be treated with a decreased concentration gradient. The trial was finished until 6 intersections from positive reaction to negative one. EC50 and EC95 of remifentanil effectively inhibiting pain response induced by vertebral balloon dilatation in the elderly patients were calculated by Probit regression analysis method. Results A total of 20 patients were enrolled, with ASA grade Ⅰ-Ⅲ. TCI of remifentanil significantly decreased the intraoperative NRS in the elderly patients scheduled for PKP. By Probit regression analysis method, EC50 and EC95 of remifentanil inhibiting the pain response induced by balloon dilation in the elderly patients undergoing percutaneous kyphoplasty was 0.950 ng/mL (95%CI: 0.768-1.103 ng/mL) and 1.179 ng/mL (95%CI: 1.049-4.595 ng/mL), respectively. Conclusions TCI of remifentanil can effectively inhibit the pain response induced by balloon dilation in the elderly patients undergoing PKP. EC50 and EC95 of remifentanil is 0.950 ng/mL and 1.179 ng/mL, respectively.

Key words: remifentanil, percutaneous kyphoplasty, target controlled infusion, median effective concentration, 95% effective concentration

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