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目的 测定右美托咪定镇静下瑞芬太尼抑制清醒气管插管反应的半数有效效应室浓度(ECe50)值.方法 选择择期困难气道全麻手术患者,年龄18 ～ 65岁,ASA Ⅰ或Ⅱ级,0.6 μg·kg-1右美托咪定10 min微泵静注后,用2％利多卡因6 mL行舌根、咽喉及声门上部表面麻醉,2％利多卡因4 mL可视软镜引导下行气管表面麻醉,同时靶控输注效应室浓度瑞芬太尼(Minto模型).完善表面麻醉5 min后,行可视软镜引导下气管内插管.瑞芬太尼的给药剂量按序贯法确定,根据预实验结果设定瑞芬太尼起始效应室靶浓度为3.0μg·L-1,各相邻浓度之间的比率为1.1.采用改良Dixon序贯公式计算出瑞芬太尼的ECe50值及95％ CI,并采用Logistic回归模型进行概率单位转换分析ECe50及95％ CI.结果 0.6 μg·kg-1右美托咪定镇静下,瑞芬太尼用于患者清醒可视软镜气管插管时的ECe50为2.26 μg·L-1,95％ CI为2.16～2.36μg·L-1.结论 右美托咪定复合瑞芬太尼可安全有效用于可视软镜引导下困难气道患者清醒插管,右美托咪定镇静下瑞芬太尼抑制清醒气管插管反应的ECe50为2.26μg·L-1.“,”AIM To determine the 50％ effective concentration(ECe50) of remifentanil in target effect-site concentration inhibiting nasotracheal intubation response in awake difficult airway patients sedated with dexmedetomidine.METHODS Patients with difficult airway,aged 18-65 years,ASA Ⅰ or Ⅱ,schedualed for selective surgery under general anaethesia were enrolled in this study.After intravenous administration of 0.6 μg · kg-1 dexmedetomidine over 10 min,the local mucous anesthesia of tongue-root,throat and supraglottic region was performed with 6 mL of 2％ lidocaine.Intratracheal topical anesthesia was performed with 4 mL of 2％ lidocaine under the guidance of glidescop.Remifentanil was administered by target-controlled infusion with Minto model at the same time.After surface anesthesia perfected for 5 min,all patients underwent intubation leading by glidescope.Effectsite concentration of remifentanil was selected for each patient according to the Sequential Method.The experiment started from effect-site concentration of remifentanil at 3.0 μg · L-1,and the ratio of two consecutive effect-site concentrations was 1.1.The ECe50 and 95％ confidence interval(CI) of remifentanil were calculated by the modified Dixon's up-and-down method,and analyzed using the probit test in a logistic regression model.RESULTS The ECe50 of remifentanil in target effect-site concentration inhibiting nasotracheal intubation response in awake difficult airway patients sedated with dexmedetomidine was 2.26 μg · L-1 (95％ CI 2.16-2.36 μg · L-1).CONCLUSION Dexmedetomidine combined with remifentanil can be safely and effectively used for awake intubation under glidescope guiding in difficult airway patients.The ECe50 of remifentanil for awake glidescope intubation is 2.26 μg · L-1 in sedated patients with 0.6 μg · kg-1 dexmedetomidine.