艾司氯胺酮单药或联合小剂量阿片类药物用于儿童包皮环切术的半数有效剂量研究  

Median effective dose of esketamine solo or in combination with low-dose opiods for pediatric patients undergoing circumcision

作　　者：李波 朱明 但颖之 白洁[1] 郑吉建 张马忠[1] LI Bo;ZHU Ming;DAN Yingzhi;BAI Jie;ZHENG Jijian;ZHANG Mazhong(Department of Anesthesiology,Shanghai Children’s Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心麻醉科,上海200127

出　　处：《上海医学》2021年第3期177-182,共6页Shanghai Medical Journal

摘　　要：目的探索艾司氯胺酮单药或与小剂量阿片类药物联合用于儿童包皮环切术所需的半数有效剂量(ED 50),并评估其血流动力学稳定性。方法采用序贯法收集2020年5—7月在上海交通大学医学院附属上海儿童医学中心行包皮环切术的3~7岁患儿72例,随机分为3组,即艾司氯胺酮单药组(E组)、芬太尼(1μg/kg)和艾司氯胺酮联用组(FE组)、舒芬太尼(0.1μg/kg)和艾司氯胺酮联用组(SE组),E组22例、FE组和SE组各25例。按序贯法的实验设计要求,根据实验方案静脉注射不同剂量的艾司氯胺酮,并记录咪达唑仑给药后3 min(T_( 0))、艾司氯胺酮给药后3 min(T _(1))、术中切皮即刻(T_( 2))、术毕即刻(T _(3))4个时间点的生命体征。结果本研究每组各确定8个交叉点。所有病例手术均成功,35例不需要追加艾司氯胺酮,其中E组11例,FE组和SE组各12例。3组间患儿的年龄、体重的差异无统计学意义(P值均>0.05)。静脉注射艾司氯胺酮后,E组、FE组和SE组患儿的睫毛反射消失时间分别为(27.1±7.4)、(23.0±5.2)和(26.3±4.2)s,苏醒时间分别为(43.4±11.3)、(42.1±11.8)和(34.2±15.0)min,3组间的差异均无统计学意义(P值均>0.05)。FE组和SE组T 1时间点的S pO 2显著低于E组同时间点(P值分别为0.001、0.003),在T_( 1)、T_( 2)和T_( 3)时间点的平均动脉压均显著低于E组同时间点(P值分别为0.015、0.004、0.039、0.010、0.034、0.027)。E组实施手术所需的艾司氯胺酮ED 50为1.88 mg/kg(95%CI:1.73~2.04),FE和SE组所需的艾司氯胺酮ED 50分别为1.91 mg/kg(95%CI:1.77~2.07)和1.72 mg/kg(95%CI:1.59~1.86),两组间的差异无统计学意义(P>0.05)。E组不良反应发生率显著低于FE组和SE组(P值均<0.05),FE组与SE组间的差异无统计学意义(P>0.05)。FE组和SE组各有7例患儿在静脉注射艾司氯胺酮后发生低氧血症,大部分患儿的S pO_( 2)维持在85%~90%,予面罩吸氧后S pO_( 2)快速恢复至正常。结论小剂量芬太尼或舒�Objective To explore the median effective dose(ED 50)of esketamine in combination with low-dose opioids and their cardiovascular stability in pediatric patients undergoing circumcision.Methods A total of 72 children aged 3-7 years old who underwent circumcision in Shanghai Children’s Medical Center between May and July 2020 were enrolled in this study.They were randomly divided into three groups:group E(n=22),group FE(n=25)and group SE(n=25).The group E was not given opioids,and the other two groups were given fentanyl(1μg/kg)or sufentanyl(0.1μg/kg)sequentially before anesthesia and then the operation was performed under esketamine intravenous anesthesia.ED 50 of esketamine was estimated by Dixon’s up-and-down method.The body movement reactions were recorded at 3 min after midazolam administration(T_(0)),3 min after esmketamine administration(T 1),immediately after skin incision(T_(2))and immediately after operation(T_(3)),so were the disappearance time of eyelash reflex,recovery time and vital signs.Results Eight crossover point were identified in each group.All the patients were successfully operated,and 35(11 in group E,12 in group FE and 12 in group SE)of them did not need additional ketamine.There was no significant difference in age or body weight between groups(all P>0.05).The disappearance time of eyelash reflex was(27.1±7.4)s in group E,(23.0±5.2)s in group FE,and(26.3±4.2)s in group SE,and the recovery time was(43.4±11.3)min,(42.1±11.8)min and(34.2±15.0)min in the corresponding groups.There was no significant difference in the disappearance time of eyelash reflex or recovery time between groups(P>0.05).S pO_(2) at T 1 and mean arterial pressure at T_( 1),T_(2) and T_(3) in group FE and group SE were significantly lower than those in group E(P=0.001,0.003,0.015,0.004,0.039,0.010,0.034,0.027).The ED 50 of esketamine was 1.88 mg/kg(95%CI:1.73-2.04)in group E,1.91 mg/kg(95%CI:1.77-2.07)in group FE and 1.72 mg/kg(95%CI:1.59-1.86)in group SE.The incidence of adverse reaction in group E was signifi

关 键 词：镇痛药 阿片类 艾司氯胺酮 儿童 包皮环切术 男性 半数有效剂量 

分 类 号：R726.1[医药卫生—儿科]