不同剂量艾司氯胺酮复合丙泊酚在儿童纤维支气管镜检查深度镇静中的应用效果  

Application of different doses of esketamine combined with propofol for deep sedation in pediatric fiberoptic bronchoscopy

作　　者：王凯利 王志涛[1] 李治松 WANG Kaili;WANG Zhitao;LI Zhisong(Department of Anesthesiology and Perioperative Medicine,the Second Affiliated Hospital,Zhengzhou University,Zhengzhou 450014)

机构地区：[1]郑州大学第二附属医院麻醉与围术期医学部,郑州450014

出　　处：《郑州大学学报(医学版)》2025年第2期241-245,共5页Journal of Zhengzhou University(Medical Sciences)

基　　金：河南省医学科技攻关计划联合共建项目(20220493)。

摘　　要：目的:探讨不同剂量艾司氯胺酮复合丙泊酚在儿童纤维支气管镜检查深度镇静中的应用效果。方法:选择6~12岁行纤维支气管镜检查的患儿,分为丙泊酚组(仅静脉注射丙泊酚镇静)和艾司氯胺酮低、中、高剂量组(静脉注射0.15、0.30、0.45 mg/kg艾司氯胺酮和丙泊酚镇静)。采用Dixon改良序贯法确定丙泊酚用量,初始丙泊酚诱导剂量为3.0 mg/kg,相邻患儿丙泊酚诱导剂量梯度差值为0.3 mg/kg,如果患儿意识消失则下一例患儿降低1个梯度,反之则升高1个梯度,出现7个交叉拐点时终止,并以4~8 mg/(kg·h)的丙泊酚维持镇静。采用Probit概率法计算丙泊酚的半数有效量(ED_(50))。比较丙泊酚总用量、诱导时间、手术时间、清醒时间以及不良反应发生情况,完全苏醒10 min时患儿麻醉苏醒期谵妄(PAED)评分和苏醒期谵妄发生情况。结果:共纳入97例患儿,其中丙泊酚组24例,艾司氯胺酮低、中、高剂量组分别为24、24和25例。丙泊酚组和艾司氯胺酮低、中、高剂量组丙泊酚诱导行纤维支气管镜检查患儿意识消失的ED_(50)(95%CI)分别为2.543(2.371~2.691)、2.409(2.199~2.585)、2.250(2.074~2.419)和2.011(1.679~2.223)mg/kg。与丙泊酚和艾司氯胺酮低剂量组比较,艾司氯胺酮中、高剂量组诱导时间减少(P<0.05);与丙泊酚组比较,艾司氯胺酮组中、高剂量呼吸暂停、低氧发生率降低,艾司氯胺酮高剂量组丙泊酚总用量减少,面罩加压通气、注射痛发生率降低,PAED评分和苏醒期谵妄发生率升高(P<0.05);与艾司氯胺酮低剂量组比较,艾司氯胺酮组高剂量组呼吸暂停和注射痛发生率降低(P<0.05)。结论:在儿童纤维支气管镜检查的深度镇静中,艾司氯胺酮剂量增加会使丙泊酚的ED_(50)下降、呼吸相关不良事件发生率减少,但苏醒期谵妄发生率增加。0.30 mg/kg的艾司氯胺酮复合丙泊酚深度镇静的呼吸相关不良事件和苏醒期谵妄发生率最低。Aim:To explore the efficacy of different doses of esketamine combined with propofol for deep sedation in pediatric fiberoptic bronchoscopy.Methods:Children aged 6-12 undergoing fiberoptic bronchoscopy were selected and divided into 4 groups:the propofol group(propofol alone for sedation)and the low-,medium-,and high-dose esketamine groups(0.15,0.30,and 0.45 mg/kg esketamine combined with propofol,respectively).The Dixon modified sequential method was used to determine the propofol dosage,with an initial induction dose of 3.0 mg/kg and a dose gradient of 0.3 mg/kg between adjacent patients.If consciousness was lost,the dose for the next patient was decreased by one gradient;otherwise,it was increased by one gradient.The procedure was terminated after 7 crossover points,and sedation was maintained with propofol at 4-8 mg/(kg·h).The median effective dose(ED_(50))of propofol was calculated using the Probit probability method.The total propofol dosage,induction time,procedure time,recovery time,and incidence of adverse events were recorded.The pediatric anesthesia emergence delirium(PAED)score and the incidence of postoperative delirium were assessed 10 minutes after full recovery.Results:A total of 97 children were included,with 24 in the propofol group and 24,24,and 25 in the low-,medium-,and high-dose esketamine groups,respectively.The ED_(50)(95%CI)of propofol for loss of consciousness in the propofol group and the low-,medium-,and high-dose esketamine groups were 2.543(2.371-2.691)mg/kg,2.409(2.199-2.585)mg/kg,2.250(2.074-2.419)mg/kg,and 2.011(1.679-2.223)mg/kg,respectively.Compared with the propofol group and the low-dose ketamine group,the induction time of the medium and high-dose esketamine groups was reduced(P<0.05);compared with the propofol group,the incidence of apnea and hypoxia was reduced in the high-dose esketamine group,while the total dose of propofol was reduced,and the incidence of mask compression ventilation and injection pain was reduced,the PAED score and the incidence of delirium during the

关 键 词：艾司氯胺酮 丙泊酚 儿童 纤维支气管镜检查 量效关系 

分 类 号：R614[医药卫生—麻醉学]