艾司氯胺酮预防无痛人工流产术中丙泊酚注射痛的有效剂量  

Effective dose of esketamine for prevention on propofol injection pain in painless abortion

作　　者：沈燕平[1] 殷利军[1] 庄文明[2] 严海雅[1] SHEN Yanping;YIN Lijun;ZHUANG Wenming;YAN Haiya(Department of Anesthesiology,Ningbo Women and Children's Hospital,Ningbo 3150012,Zhejiang,China;Department of Obstetrics and Gynecology,Ningbo Women and Children's Hospital,Ningbo 315012,Zhejiang,China)

机构地区：[1]宁波市妇女儿童医院麻醉科,浙江宁波315012 [2]宁波市妇女儿童医院妇产科,浙江宁波315012

出　　处：《中国临床药理学与治疗学》2022年第6期660-664,共5页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：宁波市公益类科技项目(2019C50090)。

摘　　要：目的:探讨艾司氯胺酮预防无痛人流术中丙泊酚注射痛的有效剂量。方法:选择2021年11月至12月拟择期行无痛人流术患者,年龄20~40岁,ASAⅠ~Ⅱ级,BMI 19~26 kg/m^(2)。采用改良序贯法进行试验,艾司氯胺酮初始剂量为0.2 mg/kg,相邻患者艾司氯胺酮剂量梯度为0.02 mg/kg,当出现丙泊酚注射痛阳性,下一例采用高一级剂量,反之采用低一级剂量,待出现七个上下交叉拐点则停止试验。采用Probit法计算艾司氯胺酮的半数有效剂量(ED_(50))和95%有效剂量(ED_(95))及其95%置信区间(CI)。记录注药前(T_(0))、艾司氯胺酮注射后(T_(1))、丙泊酚注射后(T_(2))、手术结束时(T_(3))的平均动脉压(MAP)、血氧饱和度(SpO_(2))和心率(HR)。同期观察并记录苏醒时间、恶心呕吐、谵妄、视觉异常等不良反应发生情况。结果:艾司氯胺酮预防丙泊酚注射痛的ED_(50)和ED_(95)及95%CI为0.135(0.116~0.149)mg/kg和0.170(0.153~0.252)mg/kg。与T_(0)比较,T_(1)时MAP升高,T_(2)时MAP降低,T_(2)时SpO_(2)降低(P<0.05),苏醒时间为(7.2±3.1)min,所有患者均未发生恶心呕吐、术后躁动、谵妄及视物异常等不良反应情况。结论:艾司氯胺酮缓解丙泊酚注射痛的ED_(50)和ED_(95)分别为0.135 mg/kg和0.170 mg/kg。小剂量艾司氯胺酮可以有效预防无痛人工流产术中丙泊酚注射痛并维持患者血流动力学平稳。AIM:To investigate the effective dose of esketamine for prevention on propofol injection pain in painless abortion.METHODS:From November 2021 to December 2021,thirty patients undergoing painless abortion,aged 20 to 40 years old,ASA physical statusⅠorⅡ,BMI 19-26 kg/m^(2) were enrolled.The experiment was used with a modified Dixon up and down method.The initial dose of esketamine was 0.2 mg/kg,and the dose gradient of esketamine in adjacent patients was 0.02 mg/kg.When propofol injection pain was positive,the next patient was given a high first-order dose,otherwise a low first-order dose was used,and the experiment ended when the 7 th crossovers were appeared.The ED_(50),ED_(95)and the corresponding 95%confidence interval(CI)of esketamine were calculated by Probit analysis.The values of MAP,SpO_(2)and HR were recorded before injection(T_(0)),after esketamine injection(T_(1)),after propofol injection(T_(2))and after operation(T_(3)).At the same time,the adverse reactions such as awakening time,nausea and vomiting,delirium and abnormal vision were observed and recorded.RESULTS:The ED_(50),ED_(95)and 95%CI of esketamine for prevention on propofol injection pain were 0.135(0.116-0.149)mg/kg and 0.170(0.153-0.252)mg/kg.Compared with T_(0),the value of MAP at T_(1)was significantly higher,the value of MAP and SpO_(2)at T_(2)were significantly lower(P<0.05),and the recovery time was(7.2±3.1)min.No adverse reactions such as nausea and vomiting,postoperative agitation,delirium and abnormal vision occurred in all patients.CONCLUSION:The ED_(50)and ED_(95)of esketamine for prevention on propofol injection pain were 0.135 mg/kg and 0.170 mg/kg,respectively.Low dose of esketamine can effectively prevent the pain of propofol injection during painless abortion and maintain the stability of hemodynamics.

关 键 词：艾司氯胺酮 丙泊酚 注射痛 人工流产 

分 类 号：R971.2[医药卫生—药品]