小剂量艾司氯胺酮对环泊酚抑制老年患者前列腺穿刺时体动反应半数有效剂量的影响

Effect of low⁃dose esketamine on median effective dose of ciprofol for inhibition of body movement in elderly patients undergoing prostate biopsy

目的探索小剂量艾司氯胺酮对老年患者超声引导下经会阴前列腺穿刺活检术环泊酚镇静半数有效剂量(ED_(50))的影响。方法选择行超声引导下经会阴前列腺穿刺活检术的老年男性患者49例,年龄65~75岁,BMI 18.5~30.0 kg/m^(2),ASAⅠ-Ⅲ级。将患者随机分为两组:艾司氯胺酮联合环泊酚组(E组,n=23)和环泊酚组(C组,n=26)。静脉给予舒芬太尼0.1μg/kg后,E组给予艾司氯胺酮0.2 mg/kg,C组给予等量生理盐水。采用上下序贯法确定环泊酚镇静诱导的给药剂量。E组环泊酚起始剂量为0.2 mg/kg,C组环泊酚起始剂量0.3 mg/kg,剂量梯度均为0.05 mg/kg。若患者睫毛反射消失后第1针前列腺穿刺不出现体动,下一例患者的环泊酚剂量减少0.05 mg/kg,反之下一例剂量增加0.05 mg/kg。出现7个无体动和有体动的拐点交替后终止研究。记录环泊酚总量、手术时间、苏醒时间、恢复室停留时间、低血压、心动过缓、呼吸抑制、注射痛、恶心呕吐、精神系统不良反应。采用Probit法计算环泊酚抑制体动反应的ED_(50)、95%有效剂量(ED_(95))及其95%可信区间(CI)。结果与C组比较,E组环泊酚总量明显减少(P<0.05),两组手术时间、苏醒时间、恢复室停留时间、不良反应的差异无统计学意义。E组环泊酚抑制体动反应的ED_(50)为0.22 mg/kg(95%CI 0.19~0.26 mg/kg),C组的ED_(50)为0.38 mg/kg(95%CI 0.31~0.46 mg/kg)。与C组比较,E组环泊酚抑制体动反应的ED_(50)明显降低(P<0.05)。E组环泊酚抑制体动反应的ED_(95)为0.28 mg/kg(95%CI 0.25~0.49 mg/kg),C组的ED_(95)为0.51 mg/kg(95%CI 0.44~1.25 mg/kg)。与C组比较,E组环泊酚抑制体动反应的ED_(95)明显降低(P<0.05)。结论老年患者行超声引导下经会阴前列腺穿刺活检术时环泊酚抑制体动反应的ED_(50)为0.38 mg/kg,联合小剂量艾司氯胺酮0.2 mg/kg后其ED_(50)降低至0.22 mg/kg。

Objective To explore the effects of low-dose esketamine on the median effective dose(ED_(50))of ciprofol for sedation in elderly patients undergoing ultrasound-guided transperineal prostate biopsy.Methods Forty-nine elderly male patients,aged 65-75 years,BMI 185-300 kg/m^(2),ASA physical stutasⅠ-Ⅲ,who underwent ultrasound-guided transperineal prostate biopsy,were randomly as-signed into the esketamine-ciprofol group(group E,n=23)and the ciprofol group(group C,n=26).After intravenous administration of sufentanil 0.1μg/kg,patients in group E received esketamine 0.2 mg/kg,while patients in group C received the same volume of normal saline.The up-and-down sequential allocation method was used to calculate the effective dose of ciprofol.The initial dose of ciprofol was 0.2 mg/kg in group E and 0.3 mg/kg in group C,and the dose gradient was 0.05 mg/kg for both groups.If there was no body movement during the first puncture of prostate after the loss of eyelash reflex,the ciprofol dose in the next patient was reduced by 0.05 mg/kg.Otherwise,the ciprofol dose in the next patient was in-creased by 0.05 mg/kg.The study was completed until 7 inflection points alternating between non-body movement and body movement achieved.The total amount of ciprofol,surgical time,recovery time,stay in recovery room,hypotension,bradycardia,respiratory depression,injection pain,nausea and vomiting,and adverse reaction of the mental system were recorded.The Probit method was used to calculate the ED_(50)and 95%effective dose(ED_(95))with 95%confidence interval(CI)of ciprofol for inhibition of body movement.Results Compared with group C,the total amount of ciprofol in group E was significantly reduced(P<0.05).There were no significant differences between the two groups in surgical time,recovery time,stay in recovery room,and adverse events.The ED_(50)of ciprofol in group E was 0.22 mg/kg(95%CI 0.19-0.26 mg/kg),and the ED_(50)in group C was 0.38 mg/kg(95%CI 031-046 mg/kg).Compared with group C,the ED_(50)in group E was significantly reduced(P<005).The ED_(95) of ciprofol in group E was 0.28 mg/kg(95%CI 0.25-0.49 mg/kg),and the ED_(95) in group C was 0.51 mg/kg(95%CI 0.44-1.25 mg/kg).Compared with group C,the ED_(95)in group E was significantly reduced(P<005).Conclusion The ED_(50)of ciprofol for inhibition of body movement in elderly patients undergoing ultrasound-guided transperi-neal prostate biopsy was 0.38 mg/kg,which was reduced to 0.22 mg/kg by using lose-dose esketamine 0.2 mg/kg as an adjuvant.