联合收肌管阻滞时术中泵注艾司氯胺酮用于改善全膝关节置换术患者术后疼痛的ED50  

ED50 of esketamine administered by intraoperative pumping for improvement of postoperative pain in patients undergoing total knee arthroplasty combined with adductor block

作　　者：徐紫薇 齐诗园 陈晓彤 恽惠方[2] XU Ziwei;QI Shiyuan;CHEN Xiaotong;YUN Huifang(Graduate School,Dalian Medical University,Dalian 116044,China;Department of Anesthesiology,Changzhou Second People's Hospital Affiliated to Nanjing Medical University,Changzhou 213000,China)

机构地区：[1]大连医科大学研究生院,辽宁大连116044 [2]南京医科大学附属常州市第二人民医院麻醉科,江苏常州213000

出　　处：《大连医科大学学报》2024年第1期42-46,共5页Journal of Dalian Medical University

摘　　要：目的探讨联合收肌管阻滞时术中泵注艾司氯胺酮用于改善老年全膝关节置换术(TKA)患者术后疼痛的半数有效剂量(ED50)。方法随机选取全麻下择期行单侧TKA的老年患者29例,年龄60~85岁,性别不限。术前行超声引导下收肌管阻滞并进行感觉评估。术中泵注初始剂量艾司氯胺酮0.3 mg/(kg•h),监测无创血压、心率、脉搏血氧饱和度(SpO2)等指标。记录患者在麻醉后监测治疗室(PACU)的苏醒时间及拔管后的Richmond躁动-镇静(RASS)评分,并于术后4、12、24、48小时进行静态疼痛数字评分量表(NRS)评分,24、48小时进行动态NRS评分。当患者出现阳性反应(设定为6次NRS评分有2次或以上≥4分)时表示镇痛失败,则下一例患者增加0.05 mg/(kg•h);当患者出现阴性反应(设定为6次NRS评分至少有5次≤3分)时表明镇痛成功,则下一例患者减少0.05 mg/(kg•h),直至出现第7个交叉点时终止试验。采用概率单位回归分析法计算其术中用药的ED50及其95%可信区间(95%CI)。结果共26例患者完成试验,根据术后评分可得阴性反应14例,阳性反应12例。两组患者年龄、性别、体重、身高、身体质量指数(BMI)、美国麻醉医师协会(ASA)分级、手术方位差异无统计学意义(P>0.05)。两组患者苏醒时间差异具有统计学意义(P<0.05),阴性组较阳性组明显延长[(0.57±0.09)h vs(0.45±0.08)h],两组拔管后的RASS评分差异无统计学意义(P>0.05)。统计例数中无严重并发症发生。ED50及其95%CI分别为0.237 mg/(kg•h)、0.179~0.280 mg/(kg•h)。结论联合收肌管阻滞时TKA患者术中泵注艾司氯胺酮剂量的ED50为0.237(95%CI 0.179~0.280)mg/(kg•h)。Objective To investigate the median effective dose(ED50)of esketamine and adductor canal block for adjuvant analgesia in elderly patients with total knee arthroplasty.Methods Totally,29 elderly patients(aged from 60-85 years),who underwent elective unilateral total knee arthroplasty under general anesthesia,were randomly selected.Preoperative ultrasoundguided adductor tube block and sensory evaluation were performed.The initial dose of esketamine 0.3 mg/(kg•h)was pumped intraoperatively,and noninvasive blood pressure,heart rate and pulse oxygen saturation were monitored.The wake time of the post anesthesia care unit(PACU)and the Richmond agitation-sedation scale(RASS)score after extubation were recorded,and the static numerical rating scale(NRS)was scored at 4 h,12 h,24 h,and dynamic NRS scored at 24 h,48 h and 48 h.When a patient had a positive response(2 or more of 6 NRS scores),0.05 mg/(kg•h)was added to the next patient.When a patient had a negative response(at least 5 of 6 NRS scores),the dosage in the next patient decreased by 0.05 mg/(kg•h)until the seventh crossover. Probability unit regression analysis was used to calculate the ED50 of the intraoperative medications and the 95%CI.Results A total of 26 patients completed the trial, 14 negative reactions and 12 positive reactions. There were no significantdifferences in age, sex, weight, height, body mass index (BMI), American Society of Anesthesiologists (ASA) grade, andoperative position (P>0.05). The recovery time was significantly different between the two groups (P<0.05), significantlylonger in the negative group than the positive group[(0.57±0.09) h vs (0.45±0.08) h], while the RASS scores in the two groupswere not statistically significant (P>0.05). No serious complications occurred in the statistical cases. ED50 and its 95%CI were0.237 mg/(kg • h) and 0.179-0.280 mg/(kg • h), respectively. Conclusion The ED50 of intraoperative esketamine injection was0.237 (95%CI 0.179-0.280) mg/(kg • h) in patients undergoing total knee replacement c

关 键 词：全膝关节置换术 艾司氯胺酮 收肌管阻滞 半数有效剂量 

分 类 号：R74[医药卫生—神经病学与精神病学]