不同年龄患者中复合艾司氯胺酮诱导意识消失时丙泊酚的ED_(50)和BIS_(50)  

BIS_(50)and ED_(50)of propofol for loss of consciousness when combined with esketamine for induction in different age patients

作　　者：李宁康 黑云鹏 顾洋 赵利艳 聂淏 马旭[2] 海克蓉[1] LI Ning-kang;HEI Yun-peng;GU Yang;ZHAO Li-yan;NIE Hao;MA Xu;HAI Ke-rong(Department of Anesthesiology,People's Hospital of Ningxia Hui Autonomous Region,Ningxia Medical University,Yinchuan NINGXIA 750002,China;Ningxia Medical University,Yinchuan NINGXIA 750004,China)

机构地区：[1]宁夏回族自治区人民医院(宁夏医科大学附属自治区人民医院)麻醉科,宁夏银川750002 [2]宁夏医科大学,宁夏银川750004

出　　处：《中国新药与临床杂志》2023年第12期807-811,共5页Chinese Journal of New Drugs and Clinical Remedies

基　　金：宁夏医科大学校级科研项目(XM2022062)。

摘　　要：目的明确不同年龄患者中复合艾司氯胺酮行麻醉诱导使患者意识消失时丙泊酚的半数有效剂量(ED_(50)和50%患者意识消失时的脑电双频指数值(BIS_(50))。方法选取择期行全身麻醉手术的患者,ASA分级Ⅰ~Ⅲ级,根据年龄分为A组(18~40岁)、B组(41~64岁)和C组(65~89岁)。所有患者静脉注射艾司氯胺酮0.25 mg·kg^(-1)后采用序贯法研究患者意识消失时丙泊酚的ED_(50)和BIS_(50),A组、B组、C组静脉注射丙泊酚初始剂量分别为0.56、0.50、0.46 mg·kg^(-1)。意识消失标准为睫毛反射消失且改良警觉/镇静量表(MOAA/S)评分≤2分。采用Probit回归法计算ED_(50)、BIS_(50)及其95%置信区间(95%CI),Bootstrap法计算ED_(50)、BIS_(50)的83%CI。结果复合艾司氯胺酮后,A组、B组和C组患者意识消失时丙泊酚的ED_(50)(95%CI)分别为0.68(0.64~0.75)、0.53(0.48~0.59)和0.43(0.38~0.47)mg·kg^(-1),BIS_(50)(95%CI)分别为77(74~82)、78(77~82)和81(78~83)。A组、B组和C组患者意识消失时丙泊酚的ED_(50)(83%CI)分别为0.69(0.67~0.72)、0.54(0.50~0.57)和0.43(0.40~0.45)mg·kg^(-1),BIS_(50)(83%CI)分别为75(71~80)、76(75~79)和80(76~82),ED_(50)组间比较有显著差异(P<0.05),BIS_(50)比较无显著差异(P>0.05)。结论年龄可显著影响复合艾司氯胺酮诱导患者意识消失时丙泊酚的剂量,但对BIS值的影响并不明显。AIM To determine the median effective dose(ED_(50))of propofol for loss of consciousness(LOC)and bispectral index value for LOC of 50%of patients(BIS_(50))when combined with esketamine for induction in different age patients.METHODS The patients scheduled for general anesthesia surgery with ASAⅠtoⅢwere included,and divided into group A(18 to 40 years old),group B(41 to 64 years old)and group C(65 to 89 years old)according to different ages.All patients were received of esketamine 0.25 mg·kg^(-1)intravenous injection,followed by up and down sequential method to study the ED_(50)of propofol and BIS_(50)for LOC.The initial intravenous injection doses of propofol were 0.56 mg·kg^(-1)in the group A,0.50 mg·kg^(-1)in the group B,and 0.46 mg·kg^(-1)in the group C.The disappearance of eyelash reflex and the modified observer's assessment of alert/sedation(MOAA/S)score≤2 points were defined as LOC.The ED_(50),BIS_(50),and 95%CI were determined by the Probit regression method.The Bootstrap approach was used to estimate the 83%CI of ED_(50)and BIS_(50).RESULTS By combined with esketamine for induction,the ED_(50)(95%CI)of propofol for LOC in the group A,group B,and group C were 0.68(0.64 to 0.75),0.53(0.48 to 0.59),and 0.43(0.38 to 0.47)mg·kg^(-1),while BIS_(50)(95%CI)were 77(74 to 82),78(77 to 82),and 81(78 to 83),respectively.The ED_(50)(83%CI)of propofol for LOC in the group A,group B,and group C were 0.69(0.67 to 0.72),0.54(0.50 to 0.57),and 0.43(0.40 to 0.45)mg·kg^(-1),while the BIS_(50)(83%CI)were 75(71 to 80),76(75 to 79),and 80(76 to 82),respectively.There was a significant difference in ED_(50)(P<0.05)among the three groups,but no significant difference in BIS_(50)(P>0.05).CONCLUSION Age can significantly affect the dose of propofol for LOC when combined with esketamine for induction,but has no significant effect on BIS value.

关 键 词：艾司氯胺酮 丙泊酚 麻醉 意识消失 半数有效剂量 脑电双频指数 

分 类 号：R971[医药卫生—药品]