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目的评价右美托咪啶对瑞芬太尼抑制切皮体动反应量效关系的影响。方法 150例行择期乳房肿瘤切除术患者随机分为3组:瑞芬太尼组(R组)、右美托咪啶0.5μg.kg-1+瑞芬太尼组(D1R组)和右美托咪啶1.0μg.kg-1+瑞芬太尼组(D2R组),每组50例,D1R和D2R组分别输注右美托咪啶0.5和1.0μg.kg-1,持续时间为15 min,R组则泵注生理盐水。将每组患者随机分为5个亚组,每亚组10例,在输注右美托咪啶或生理盐水结束后效应室靶控不同浓度的瑞芬太尼。所有患者在靶控瑞芬太尼的同时效应室靶控输注丙泊酚3mg.L-1,3 min后切开乳房皮肤3 cm,观察患者有无体动反应。用Probit法计算抑制体动反应瑞芬太尼的5%有效效应室浓度(EC5),半数有效效应室浓度(EC50)和95%有效效应室浓度(EC95)及其各自95%可信区间(95%CI)。结果D1R和D2R组EC5、EC50和EC95均低于R组(P<0.0167),D2R组EC5、EC50和EC95低于D1R组(P<0.0167)。结论右美托咪啶剂量依赖性的减少抑制体动反应所需的瑞芬太尼剂量。
Objective To evaluate the effect of dexmedetomidine on the dose-response relationship between remifentanil and cutaneous motor responses. Methods 150 patients undergoing elective breast cancer resection were randomly divided into three groups: remifentanil group (R group), dexmedetomidine 0.5μg.kg-1 + remifentanil group (D1R group) and dexmedetomidine (D2R group), 50 patients in each group, 0.5 mg dexmedetomidine and 1.0 μg.kg-1 dexmedetomidine respectively in D1R and D2R groups for a duration of 15 min, R group was injected with saline. Each group of patients were randomly divided into 5 subgroups, 10 cases in each subgroup. Different concentrations of remifentanil were targeted in the effector chamber after the infusion of dexmedetomidine or normal saline. All patients under the target of remifentanil at the same time the target room infusion of propofol propofol 3mg.L-1, 3 min after the incision of the breast skin 3 cm to observe the patient with or without physical reaction. Probit method was used to calculate EC50, EC50 and 95% EC50 of remifentanil and their respective 95% confidence interval (EC50) of inhibition of body movement response to remifentanil 95% CI). Results The levels of EC5, EC50 and EC95 in D1R and D2R groups were lower than those in R group (P <0.0167), while those in D2R group were lower than those in D1R group (P <0.0167). Conclusion Dexmedetomidine dose-dependently reduced the remifentanil dose required to inhibit body motion.