艾司氯胺酮联合舒芬太尼在髋关节置换术中辅助镇痛的有效剂量  

Effective dose of esketamine combined with sufentanil for adjuvant analgesia in hip replacement

作　　者：李洪超 宁林 张琦玮 黄炳强 毛庆祥 闫红 LI Hong-chao;NING Lin;ZHANG Qi-wei;HUANG Bing-qiang;MAO Qing-xiang;YAN Hong(Department of Anesthesiology,Army Medical Center of PLA,Chongqing 400042,China)

机构地区：[1]陆军特色医学中心麻醉科,重庆400042

出　　处：《局解手术学杂志》2023年第3期221-224,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：陆军军医大学科技创新能力提升专项(2019XLC3053);军队重大专项课题子课题。

摘　　要：目的探讨亚麻醉剂量艾司氯胺酮联合舒芬太尼在髋关节置换术中辅助镇痛的半数有效剂量(ED_(50))和95%有效剂量(ED_(95))。方法选取择期行髋关节置换术患者29例,腰丛联合坐骨神经阻滞麻醉后,手术切皮前5 min予以艾司氯胺酮和舒芬太尼0.2μg/kg,选择艾司氯胺酮亚麻醉剂量0.2 mg/kg为起始,剂量梯度为0.05 mg/kg,采用序贯法进行试验。统计艾司氯胺酮辅助麻醉的阳性反应情况。记录患者神经阻滞操作前(T0)、艾司氯胺酮给药即刻(T1)、艾司氯胺酮给药结束(T2)、术中切皮即刻(T3)、切皮后5 min(T4)、切皮后20 min(T5)平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(SpO_(2))、呼吸频率(RR)、脑电双频指数(BIS)、视觉模拟量表(VAS)评分和Ramsay评分,同时观察不良反应发生情况。采用Probit法计算艾司氯胺酮在髋关节置换术中辅助镇痛的ED_(50)、ED_(95)。结果艾司氯胺酮术中辅助镇痛的阳性率为48.3%。与T0时相比,T1、T2、T4、T5时MAP、RR、HR、SpO_(2)差异无统计学意义(P>0.05),T3时RR、SpO_(2)稍降低,差异有统计学意义(P<0.05)。与T0时相比,T2~T5时BIS降低,Ramsay评分升高,T3、T4时患者VAS评分升高,差异均有统计学意义(P<0.05)。艾司氯胺酮在髋关节置换术中不良反应少,辅助镇痛的ED_(50)为0.207 mg/kg,95%CI为0.162~0.247 mg/kg;ED_(95)为0.298 mg/kg,95%CI为0.254~0.570 mg/kg。结论亚麻醉剂量艾司氯胺酮联合舒芬太尼用于髋关节置换术的辅助镇痛的ED_(50)为0.207 mg/kg,ED_(95)为0.298 mg/kg;其能够取得满意的镇痛效果,并发症少,可促进患者术后早期恢复。Objective To investigate the 50%effective dose(ED_(50))and 95%effective dose(ED_(95))of esketamine combined with sufentanil for adjuvant analgesia in hip replacement.Methods A total of 29 patients undergoing elective hip replacement were selected,and after lumbar plexus combined with sciatic nerve block anesthesia,they were given esketamine and 0.2μg/kg of sufentanil 5 minutes before incision,the sequential method was conducted by selecting 0.2 mg/kg as the starting point of ketamine subanesthetic dose and 0.05 mg/kg as the dose gradient.The mean arterial pressure(MAP),heart rate(HR),saturation of peripheral oxygen(SpO_(2)),respiratory rate(RR),bispectral index(BIS),visual analogue scale(VAS)score and Ramsay score were recorded before nerve block operation(T0),immediately after the administration of esketamine(T1),after the administration of esketamine(T2),immediately after intraoperative incision(T3),5 minutes after incision(T4),and 20 minutes after incision(T5)were recorded,and the occurrence of adverse reactions was observed.The Probit method was used to calculate the ED_(50)and ED_(95)of esketamine for adjuvant analgesia in hip replacement.Results The postive rate of esketamine for intraoperative adjuvant analgesia was 48.3%.Compared with T0,there was no significant difference in MAP,RR,HR or SpO_(2)at T1,T2,T4 and T5(P>0.05),and RR and SpO_(2)at T3 slightly decreased,with statistically significant differences(P<0.05).Compared with T0,BIS was decreased and Ramsay score was increased at T2 to T5,VAS scores at T3 and T4 were increased,with statistically significant differences(P<0.05).Esketamine in hip replacement had fewer adverse reactions,the ED_(50)for adjuvant analgesia was 0.207 mg/kg,with 95%CI of 0.162 to 0.247 mg/kg,and ED_(95)was 0.298 mg/kg,with 95%CI of 0.254 to 0.570 mg/kg.Conclusion The ED_(50)and ED_(95)of subanesthetic dose of esketamine combined with sufentanil for adjuvant analgesia in hip replacement were 0.207 mg/kg and 0.298 mg/kg respectively.It can achieve satisfactory analgesic effect w

关 键 词：艾司氯胺酮 舒芬太尼 髋关节置换 剂量-效应关系 镇痛 

分 类 号：R614[医药卫生—麻醉学]