右美托咪定联合固定剂量艾司氯胺酮诱导儿童睡眠气道镜检查的药物半数有效剂量探讨  

Median effective bolus dose of dexmedetomidine combined with S(+)-ketamine for drug-induced sleep endoscopy in pediatric obstructive sleep apnea

作　　者：王璐[1] 张瑞冬[1] 张莺 白洁[1] 郑吉建 WANG Lu;ZHANG Ruidong;ZHANG Ying;BAI Jie;ZHENG Jijian(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》2022年第3期171-174,共4页Shanghai Medical Journal

基　　金：上海市科学技术委员会医学引导类(中、西医)科技支撑项目(17411965500);国家自然科学基金(81771218)。

摘　　要：目的探讨右美托咪定联合艾司氯胺酮用于阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)患儿行药物诱导睡眠气道镜(drug-induced sleep endoscopy,DISE)检查的半数有效剂量(ED_(50))。方法纳入22例拟行DISE检查的OSA患儿,年龄2~12岁,ASA分级Ⅱ或Ⅲ级。在10 min内静脉泵注预设剂量右美托咪定并同步静脉注射艾司氯胺酮(剂量为0.5 mg/kg)。根据Dixon序贯法计算右美托咪定诱导剂量,初始剂量设为1.0μg/kg(剂量间隔为1.2倍)。麻醉诱导后行DISE检查,记录患儿对首次操作的反应和生命体征变化。根据Dixon和Massey公式计算右美托咪定麻醉诱导的ED_(50)。结果有9例OSA患儿一次性镇静成功并完成DISE检查。联合0.5 mg/kg艾司氯胺酮时,右美托咪定麻醉诱导儿童DISE检查的ED_(50)为1.9μg/kg。给药后患儿心率减慢、舒张压升高(P值均<0.05)。无患儿发生严重呼吸抑制。结论OSA患儿于0.5 mg/kg艾司氯胺酮联合右美托咪定麻醉诱导下行DISE检查时,右美托咪定的ED_(50)为1.9μg/kg。Objective To determine the median effective bolus dose(ED_(50))of dexmedetomidine required for drug-induced sleep endoscopy(DISE)in children with obstructive sleep apnea(OSA).Methods Twenty-two OSA patients,aged 2-12 years old,American Society of Anesthesiologists(ASA)physical statusⅡorⅢ,and scheduled for DISE were enrolled in this study.A predetermined bolus dose of dexmedetomidine was used for anesthesia induction in 10 min,and S(+)-ketamine 0.5 mg/kg was intravenously injected simultaneously.The inducing dose of dexmedetomidine was calculated according to the Dixon up-and-down method,and the initial dose was set as 1.0μg/kg(dose interval was 1.2 times).The response of the patients to the procedure was recorded.ED_(50) of dexmedetomidine for anesthesia induction was calculated according to Dixon and Massey formula.Results DISE was smoothly performed in 9 patients.In combination with S(+)-ketamine 0.5 mg/kg,the ED_(50) of dexmedetomidine was 1.9μg/kg during DISE.After administration,the heart rate were decreased,and the diastolic blood pressure was increased(all P<0.05).No severe respiratory depression occurred.Conclusion The ED_(50) of dexmedetomidine for successful DISE in children with OSA is 1.9μg/kg during anesthesia induction with S(+)-ketamine 0.5 mg/kg.

关 键 词：儿童 右美托咪定 睡眠呼吸暂停 阻塞性 艾司氯胺酮 

分 类 号：R614[医药卫生—麻醉学]