丙泊酚复合小剂量艾司氯胺酮抑制胃镜置入反应的有效剂量

Effective dose of propofol combined with low-dose esketamine inhibiting response to gastroscopy insertion

目的探讨丙泊酚复合小剂量艾司氯胺酮抑制胃镜置入反应的有效剂量。方法选择2020年10—11月自愿接受无痛胃镜检查的患者26例,男14例,女12例,年龄18~64岁,BMI 18~25 kg/m^(2),ASAⅠ或Ⅱ级。所有患者静脉注射艾司氯胺酮0.3 mg/kg,注射后30 s给予丙泊酚,初始剂量为3.5 mg/kg。采用序贯法进行试验,相邻患者丙泊酚剂量公比为0.9,如置入胃镜出现阳性反应(呛咳、体动等)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概率法计算丙泊酚的半数有效剂量(ED_(50))、95%有效剂量(ED_(95))及相应95%可信区间(CI)。记录苏醒时间、苏醒后10 min的VAS疼痛评分。记录低血压、呼吸抑制(SpO_(2)<90%)、恶心呕吐、复苏期躁动、苏醒延迟等不良反应发生情况。结果丙泊酚复合艾司氯胺酮0.3 mg/kg时抑制患者胃镜置入反应的ED_(50)为1.691 mg/kg(95%CI 1.498~1.851 mg/kg),ED_(95)为2.032 mg/kg(95%CI 1.864~3.123 mg/kg),苏醒时间为(11.7±3.2)min,苏醒后10 min的VAS疼痛评分为(1.6±0.4)分。所有患者未发生低血压、苏醒期躁动及苏醒延迟,1例出现呼吸抑制,1例出现呕吐。结论丙泊酚复合小剂量艾司氯胺酮时抑制患者胃镜置入反应的半数有效剂量及95%的有效剂量分别为1.691 mg/kg和2.032 mg/kg,苏醒质量高,无明显不良反应。

Objective To investigate the effective dose of propofol inhibiting response to gastroscopy insertion when combined with low-dose esketamine in patients.Methods Twenty-six patients scheduled for elective gastroscopy from Octomber 2020 to November 2020,14 males and 12 females,aged 18-64 years,ASA physical stateⅠorⅡ.Propofol 3.5 mg/kg was given after esketamine 0.3 mg/kg for 30 seconds.Dose of propofol was determined by up-and-down sequential method,the common ratio of propofol dose in adjacent patients is 0.9.When the response to gastroscopy insertion was positive reaction(choking,body movement,etc.),the dose of propofol 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))and 95%effective dose(ED_(95))and the corresponding 95%confidence interval(CI).Time to awakening,and VAS score 10 minutes after awaken was recorded.Hypotension,respiratory depression(SpO_(2)<90%),nausea and vomiting,recovery agitation,delayed recovery were recorded.Results The ED_(50) of propofol inhibiting response to gastroscopy insertion in patients was 1.691 mg/kg(95%CI 1.498-1.851 mg/kg),ED_(95) was 2.032 mg/kg(95%CI 1.864-3.123 mg/kg).The time to awakening was(11.7±3.2)minutes,VAS score 10 minutes after awaken was(1.6±0.4)scores.No hypotension,recovery agitation and delayed recover occurred in all patients.One patient occurred respiratory depression and 1 patient occurred vomiting.Conclusion The ED_(50) and ED_(95) of propofol inhibiting response to gastroscopy insertion in patients when combined with 0.3 mg/kg esketamine were 1.691 mg/kg and 2.032 mg/kg respectively,with a high quality of awakening and no significant adverse effects.