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摘要：
目的 探索瑞芬太尼复合丙泊酚时抑制胃镜置入反应的95%有效剂量（ED95）。方法 选择我院消化内镜中心行胃镜检查者55例,年龄18~55岁, 体重指数（body mass index, BMI）在20~28 kg/m2, 美国麻醉医师学会（Ameri can Society of Anesthesiologists, ASA）分级Ⅰ~Ⅱ级，无吸烟史。预先缓慢静脉注射瑞芬太尼(推注时间30 s以上),1 min后泵注丙泊酚1 mg/kg负荷量（速度为1 ml/10 s），直至双频谱指数（Bispectral Index, BIS）在50左右开始行胃镜检查。瑞芬太尼首剂量为0.12 μg/kg，据抛偏倚硬币序贯法决定下一受试者剂量，若上一受试者胃镜置入反射为阳性，下一受试者升高１个剂量梯度；若上一受试者胃镜成功置入，那么下一个受试者有11%的可能性下降1个剂量梯度，而89%的可能性保持上一个病例的剂量梯度。剂量梯度为0.02 μg/kg。胃镜置入阳性标准为：置镜时或置镜1 min内出现呛咳、呕吐或严重体动反应，以及心率血压变化超过基础值的20%。当出现45例阴性病例后则研究结束，并计算联合丙泊酚背景下瑞芬太尼有效抑制胃镜置入反应的50%有效剂量(ED50)，ED95及其相应的95%置信区间（CI）。结果 复合丙泊酚时瑞芬太尼抑制胃镜置入反应的ED50为0.149 μg/kg （95% CI 0.124~0.160 μg/kg），ED95为0.184 μg/kg（95% CI 0.173~0.213 μg/kg）。结论 复合丙泊酚背景下单次注射瑞芬太尼抑制胃镜置入反应的ED95为0.184 μg/kg。
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Abstract: Objective To explore the 95% effective dose (ED95) of remifentanil for inhibiting responses to gastroscopy when combined with propofol. Methods Fifty-five patients who underwent gastroscopy at our gastrointestinal endoscopy center, aged 18-55 years, body mass index (BMI) 20-28 kg/m2, American Society of Anesthesiologists (ASA) Ⅰ or Ⅱ, and no smoking history were enrolled. Remifentanil was injected slowly intravenously more than 30 s in advance, then 1 mg/kg loading dose of propofol was pumped at a rate of 1 ml/10 s after 1 min till the Bispectral Index (BIS) value was around 50, and then the gastroscopy was started. The initial dose of remifentanil was 0.12 μg/kg, and the dose of the next subject was determined according to the biased coin design sequential method. If the gastroscopy insertion response of the previous examiner was positive, the next subject was elevated by one dose gradient. If the insertion was successful, there was a probability that the next patient would be lowered by one dose gradient with a probability of 11% and a probability 89% of maintaining previous dose, the dose gradient was 0.02 μg/kg. The insertion response of gastroscopy was defined as choking, vomiting, severe motor reactions, and a change in heart rate and blood pressure of more than 20% of the basal value when gastroscopy entering the entrance of the esophagus or within one min. The trial was terminated when there were 45 negative cases, and the 95% effective dose (ED50), ED95, and their 95% confidence intervals (CI) were calculated for the inhibition of the response to gastroscopic placement by remifentanil in combination with propofol. Results The ED50 for remifentanil in combination with propofol to inhibit the response to gastroscopic placement was 0.149 μg/kg (95% CI 0.124 to 0.160 μg/kg) and the ED95 was 0.184 μg/kg (95% CI 0.173 to 0.213 μg/kg). Conclusion The ED95 of a single injection of remifentanil for inhibiting the response to gastroscopic placement was 0.184 μg/kg when combined with propofol intravenous injection.
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