| 摘要: |
| 目的：确定经皮穴位电刺激对咪达唑仑致意识消失半数有效靶浓度（EC50）的影响。方法：选择择期椎管内麻醉行骨科下肢手术患者 53 例，随机分为经皮穴位电刺激组（T 组）和对照组（C 组），实施椎管内麻醉。T 组给予经皮穴位电刺激，选择双侧合谷穴、内关穴，20 min 后静脉注射咪达唑仑。C 组在相应穴位贴电极片，并连接刺激器，不予电刺激。警觉 / 镇静（OAA/S）评分≤ 2 分为意识消失。采用序贯法确定咪达唑仑靶控输注浓度，初始靶浓度为 80 ng/mL，相邻剂量比为 1:1.1，若患者意识消失，则下 1 例咪达唑仑剂量下调一个剂量梯度；若意识未消失，则下 1 例咪达唑仑剂量上调一个剂量梯度。当出现 7 次阴阳交叉时终止。采用序贯法公式法计算咪达唑仑致患者意识消失半数有效量（EC50）及其95% 可信区间。结果：T 组咪达唑仑至患者意识消失的 EC50 为 78.6 ng/mL[95% 置信区间为（53.1~116.4）ng/mL]，C 组为 90.3 ng/mL [95% 置信区间为（61.4~132.7）ng/mL]，差异有统计学意义（P<0.05）。结论：经皮穴位电刺激可降低咪达唑仑致患者意识消失 EC50。 |
| 关键词: 经皮穴位电刺激 咪达唑仑 靶控输注 剂量效应关系 药物 |
| DOI：10.3969/j.issn.1007-6948.2019.04.006 |
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| 基金项目:天津市卫生和计划生育委员会中医中西医结合科研课题（2017074） |
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| Effect of Transcutaneous Electrical Acupoint Stimulation on Half Effective Target Concentration in Patients with Midazolam Induced Disappearance |
| GUO Yan-hui,ZHAO Chong-fa |
| Department of anesthesiology, Tianjin Haihe Hospital, Tianjin (300350), China |
| Abstract: |
| Objective To determine the effect of transcutaneous electrical acupoint stimulation (TEAS) on half effective target concentration (EC 50 ) in patients with consciousness loss induced by midazolam. Methods Selective spinal anesthesia for orthopedic lower limb surgery patients were randomly divided into two groups: percutaneous acupoint electrical stimulation group (T group) and control group (C group), using implementation of intraspinal anesthesia. The patients in T group were given TEAS, and the stimulation current was adjusted to the maximum intensity that the patient could tolerate. Bilateral Hegu and Neiguan points were selected and midazolam was injected intravenously 20 min later. In group C, the electrodes were attached to the corresponding points, and the stimulator was connected without electrical stimulation. OAA/S score of less than 2 points was judged to be a loss of consciousness. The initial target concentration of midazolam was 80ng/mL and the adjacent dose ratio was 1: 1. 1. If the patient’s consciousness disappeared, the next patient’s midazolam dose was lowered by a dose gradient, whereas the next patient’s midazolam dose was increased by a dose gradient if the consciousness did not disappear. When the 7 Yin Yang crosses occurred, the experiment was terminated. Half effective dose (EC50) and 95% con?dence interval (CI) of midazolam-induced consciousness loss were calculated by sequential formula. Results The EC50 from midazolam to unconsciousness was 78.6 ng/mL in group T (53.1–116.4 ng/mL in 95% CI) and 90.3 ng/mL in group C (61.4–132.7 ng/mL in 95% CI). The difference was statistically signi?cant (P<0.05). Conclusion TEAS can reduce the consciousness loss of midazolam patients in EC50. |
| Key words: Transcutaneous electrical acupoint stimulation midazolam Target controlled infusion dose effect relationship drugs |
