中国急诊患儿应用氯胺酮进行程序化镇静镇痛对眼压的影响

Influence of ketamine on intraocular pressure in the treatment of procedural sedation and analgesia for Chinese emergency children

目的探讨氯胺酮在进行程序化镇静镇痛（procedural sedation andanalgesia,PSA）中对眼压的影响。方法为对急诊室内需要氯胺酮PSA治疗患儿的前瞻性非劣效性研究,于PSA之前、氯胺酮注射后即时、2.5、5以及10 min测量并分析患者右眼眼压。结果共入组83例患者（其中49例（59%）为男性,1-5年龄组28例患者,6-10年龄组26例患者,11-15年龄组29例患者）。平均氯胺酮静脉注射总量为1.6 mg/kg（95%CI=1.4-1.7）。眼压基线均值为17.5 mm Hg（1 mm Hg=0.133 kPa）（95%CI=16.4-18.6 mm Hg）,注射氯胺酮2.5 min后的眼压均值为18.9 mm Hg（95%CI=17.9-19.9 mm Hg）。其平均差为1.4 mm Hg（95%CI=0.4-2.4 mm Hg）,非劣性边界为2.6 mm Hg（15%）。结论给予急诊患儿常规程序化镇静镇痛剂量的氯胺酮并没显著增加眼压。仍需更多研究来评估对于有眼部疾病患者应用氯胺酮的安全性。

Objective To investigate the influence of ketamine on intraocular pressure in the treatment of procedural sedation andanalgesia（PSA）. Methods A prospective and non-inferiority study was made for the children needed ketamine in the treatment of PSA. The intraocular pressure of right eyes of the patients were measured before PSA, after ketamine injection immediate, and 2.5 min, 5 min, 10 min after injection. Results There were 83 patients enrolled in this study（49 cases（59%） were male, 28 cases were in 1 to 5-year-old group, 26 cases were in 6 to 10-year-old group, and 29 cases were in 11 to 15-year-old group）. The total average intravenous injection amount of ketamine was 1.6 mg/kg（95%CI=1.4-1.7）. Mean value of intraocular pressure（IOP） baseline was 17.5 mmHg（1 mm Hg=0.133 kPa）（95%CI=16.4-18.6 mm Hg）. Mean value of IOP baseline after ketamine injection for 2.5 min was 18.9 mmHg（95%CI=17.9-19.9 mm Hg）. The average deviation was 1.4 mmHg（95%CI=0.4-2.4 mm Hg）, and the non-inferiority boundary was 2.6 mmHg（15 %）. Conclusion Ketamine in the treatment of PSA for emergency pediatric patients does not signi-cantly increase IOP. Further study is needed for assessing its safety in patients with ocular disease.