艾司氯胺酮联合右美托咪定及利多卡因麻醉诱导抑制气管插管反应  

Esketamine combined with dexmedetomidine and lidocaine induced inbition of tracheal intubation response

作　　者：邓东香 吴多志 DENG Dongxiang;WU Duozhi(Department of Anesthesiology,Hainan Affiliated Hospital of Hainan Medical University(Hainan General Hospital),Haikou 570311,China)

机构地区：[1]海南医学院附属海南医院海南省人民医院麻醉科,海南海口570311

出　　处：《新医学》2024年第5期335-341,共7页Journal of New Medicine

基　　金：海南省重点研发计划项目(ZDYF2021SHFZ087)。

摘　　要：目的探讨艾司氯胺酮联合右美托咪定及利多卡因无阿片化麻醉(OFA)的麻醉诱导抑制气管插管反应的半数有效剂量(ED_(50))。方法选择18~59岁、BMI18~30 kg/m^(2),美国麻醉医师协会分级Ⅰ或Ⅱ级的择期行气管插管全身麻醉手术的成年患者。艾司氯胺酮初始剂量为0.5 mg/kg,使用序贯法,根据气管插管反应决定下一例患者的剂量,相邻剂量的比例为1∶1.1,麻醉诱导采用艾司氯胺酮联合右美托咪定及利多卡因,计算艾司氯胺酮抑制气管插管反应的ED_(50)及其相应的95%CI。结果共有29例患者被纳入统计分析。气管插管反应阳性(阳性组)15例、反应阴性(阴性组)14例。阳性组共有3例在气管插管过程中出现呛咳反应。艾司氯胺酮抑制气管插管反应的ED_(50)为0.448 mg/kg,相应的95%CI为0.421~0.476 mg/kg。结论在进行艾司氯胺酮联合右美托咪定及利多卡因的OFA时,对于抑制气管插管反应,0.448 mg/kg的艾司氯胺酮能引起50%最大反应强度。Objective To investigate the median effective dose(ED_(50))of esketamine for inhibiting tracheal intubation response during the induction of dexmedetomidine combined with lidocaine under opioid-free anesthesia(OFA).Methods Adult patients aged 18-59 years with body mass index(BMI)<30 kg/m^(2)and ASA gradeⅠorⅡwere selected for endotracheal intubation general anesthesia.Dixon sequential method was adopted.The initial dose of esketamine was 0.5 mg/kg,and the dose of the next patient was determined according to the tracheal intubation response.The ratio of adjacent doses was 1∶1.1.The ED_(50) and 95%confidence interval(CI)of esketamine for inhibiting tracheal intubation response during the induction of dexmedetomidine combined with lidocaine OFA were calculated.Results A total of 29 patients were included for statistical analysis.Tracheal intubation reaction was positive in 15 cases(positive group)and negative in 14 cases(negative group).In the positive group,3 cases had cough reaction during tracheal intubation.The ED_(50) of esketamine for inhibiting tracheal intubation response during the induction of dexmedetomidine combined with lidocaine OFA was 0.448 mg/kg,and the corresponding 95%CI was 0.421-0.476 mg/kg.Conclusion In the OFA of esketamine combined with dexmedetomidine and lidocaine,0.448 mg/kg of esketamine results in 50%of the maximum response intensity for inhibiting tracheal intubation response.

关 键 词：艾司氯胺酮 无阿片化麻醉 气管插管 半数有效剂量 序贯法 

分 类 号：R614[医药卫生—麻醉学]