复合丙泊酚时艾司氯胺酮抑制不同年龄患者胃镜置入反应的有效剂量  

Effective dose of esketamine inhibiting responses to gastroscopy insertion when combined with propofol in patients of different ages

作　　者：邓丽珍[1] 尹泉 曾伟[1] 谭美云[1] 何干玲[1] 张春元[1] DENG Li-zhen;YIN Quan;ZENG Wei;TAN Mei-yun;HE Gan-ling;ZHANG Chun-yuan(Department of Anesthesiology,Boai Hospital of Zhongshan,Zhongshan GUANGDONG 528400,China)

机构地区：[1]中山市博爱医院麻醉科,广东中山528400

出　　处：《中国新药与临床杂志》2024年第1期35-39,共5页Chinese Journal of New Drugs and Clinical Remedies

摘　　要：目的探讨复合丙泊酚时艾司氯胺酮抑制胃镜置入反应的有效剂量,及其与年龄的关系。方法择期行无痛胃镜检查的患者,按年龄分为青年组(年龄18~40岁)、中年组(年龄41~64岁)和老年组(年龄65~80岁)。各组患者均给予丙泊酚1.5 mg·kg^(-1)复合艾司氯胺酮静脉麻醉,采用序贯法进行试验,艾司氯胺酮初始剂量为0.2 mg·kg^(-1),根据胃镜置入反应的情况,确定下一例患者艾司氯胺酮的剂量,相邻患者剂量比为1.1,如置入胃镜出现阳性反应则下一例患者升高一个梯度,反之则降低一个梯度,待出现7个交叉拐点则终止该研究。采用Probit概率法计算艾司氯胺酮的半数有效剂量(ED_(50))、95%有效剂量(ED_(95))及相应95%置信区间(95%CI)。记录生命体征、苏醒质量和不良反应发生情况。结果复合丙泊酚1.5 mg·kg^(-1)时艾司氯胺酮抑制不同年龄患者胃镜置入反应的有效剂量:青年组ED_(50)为0.192 mg·kg^(-1)(95%CI:0.181~0.202 mg·kg^(-1)),ED_(95)为0.209 mg·kg^(-1)(95%CI:0.200~0.255 mg·kg^(-1));中年组ED_(50)为0.157 mg·kg^(-1)(95%CI:0.106~0.183 mg·kg^(-1)),ED_(95)为0.202 mg·kg^(-1)(95%CI:0.179~0.576 mg·kg^(-1));老年组ED_(50)为0.113 mg·kg^(-1)(95%CI:0.085~0.131 mg·kg^(-1)),ED_(95)为0.150 mg·kg^(-1)(95%CI:0.131~0.303 mg·kg^(-1))。老年组出现低血压2例,呼吸抑制1例,其他2组无明显不良反应发生。结论复合丙泊酚1.5 mg·kg^(-1)时,艾司氯胺酮抑制不同年龄患者胃镜置入反应的ED_(50)和ED_(95)有随年龄增长而递减的趋势。AIM To investigate the effective dose of esketamine inhibiting responses to gastroscopy insertion when combined with propofol in patients of different ages.METHODS Patients scheduled for painless gastroscopy were selected and divided into three groups according to different ages:youth group(aged 1-40 years),middle age group(aged 41-64 years),and elderly group(aged 65-80 years).All patients were given propofol 1.5 mg·kg^(-1) combined with esketamine under intravenous anesthesia,dose of esketamine was determined by up-and-down sequential method,the initial dose of esketamine set at 0.2 mg·kg^(-1),and the common ratio of esketamine dose in adjacent patients was 1.1.When the response to gastroscopy insertion was positive reaction,the dose of esketamine was increased in the next patient,and decreased vice versa.The test ended after 7 crossovers were obtained.Probit analysis was used to calculate the median effective dose(ED_(50)),95%effective dose(ED_(95)),and the corresponding 95%confidence interval(CI).Vital signs,awakening time,and the occurrence of adverse reactions were recorded.RESULTS The effective dose of esketamine inhibiting responses to gastroscopy insertion in patients of different ages when combined with propofol 1.5 mg·kg^(-1):the ED_(50) of the young group was 0.192 mg·kg^(-1)(95%CI:0.181 to 0.202 mg·kg^(-1)),ED_(95) was 0.209 mg·kg^(-1)(95%CI:0.200 to 0.255 mg·kg^(-1));the ED_(50) of the middle age group was 0.157 mg·kg^(-1)(95%CI:0.106 to 0.183 mg·kg^(-1)),ED_(95) was 0.202 mg·kg^(-1)(95%CI:0.179 to 0.576 mg·kg^(-1));the ED_(50) was 0.113 mg·kg^(-1)(95%CI:0.085 to 0.131 mg·kg^(-1))and ED_(95) was 0.150 mg·kg^(-1)(95%CI:0.131 to 0.303 mg·kg^(-1))in the elderly group.There were 2 cases of hypotension and 1 case of respiratory depression in the elderly group,while there were no significant adverse reactions in the other two groups.CONCLUSION When combined with propofol 1.5 mg·kg^(-1),the ED_(50) and ED_(95) of esketamine inhibiting response to gastroscopy insertion in patients of differen

关 键 词：丙泊酚 艾司氯胺酮 胃镜检查 剂量效应关系 药物 序贯法 

分 类 号：R971[医药卫生—药品]