性别对亚麻醉剂量艾司氯胺酮下环泊酚用于胃肠镜检查半数有效量的影响

Effect of gender on the half effective dose of ciprofol under subanesthetic esketamine for gastroenteroscopy

目的探索性别对亚麻醉剂量艾司氯胺酮下环泊酚用于胃肠镜检查半数有效量(ED_(50))的影响。方法选择拟行无痛胃肠镜检查的患者77例,年龄18~65岁,分为H组(性别不限,25例)、M组(均为男性,24例)、W组(均为女性,28例)。患者麻醉诱导时先缓慢静脉推注艾司氯胺酮0.2 mg/kg,注射后30 s再静脉推注环泊酚。设定环泊酚初始剂量为0.4 mg/kg,剂量梯度0.05 mg/kg,采用Dixon改良序贯法决定下一例患者环泊酚剂量。使用概率单位Probit回归分析法分析3组患者亚麻醉剂量艾司氯胺酮下环泊酚用于胃肠镜检查的ED_(50)、95%有效量(ED_(95))及其95%置信区间(CI)。记录患者麻醉诱导前(T_(0))、给药后(T_(1))时的平均动脉压(MAP)、收缩压(SBP)、舒张压(DBP)、心率及围手术期麻醉相关不良反应。结果亚麻醉剂量艾司氯胺酮用于胃肠镜检查时环泊酚的ED_(50)及其95%CI:H组为0.349(0.306~0.387)mg/kg,M组为0.338(0.262~0.388)mg/kg,W组为0.407(0.363~0.451)mg/kg。亚麻醉剂量艾司氯胺酮用于胃肠镜检查时环泊酚的ED_(95)及其95%CI:H组为0.427(0.389~0.655)mg/kg,M组为0.439(0.389~0.903)mg/kg,W组为0.499(0.454~0.780)mg/kg。与W组比较,M组亚麻醉剂量艾司氯胺酮下环泊酚行胃肠镜检查时的ED_(50)、ED_(95)较低(均P<0.05)。与T_(0)比较,3组患者T_(1)时SBP、DBP、MAP、心率下降(均P<0.05)。W组1例患者诉有头晕,休息后缓解,3组患者苏醒期均未发生明显恶心呕吐及精神类问题。结论0.2 mg/kg艾司氯胺酮联合环泊酚用于胃肠镜检查时循环稳定,较适用于胃肠镜检查,女性环泊酚ED_(50)较男性增加20.41%、ED_(95)较男性增加13.67%,可为临床用药提供指导。

Objective To explore the effect of gender on the median effective dose(ED_(50))of ciprofol under subanesthetic es‑ketamine for gastroenteroscopy.Methods A total of 77 patients aged 18‒65 years old were enrolled and divided into three groups:group H(n=25,no gender restrictions),group M(n=24,all male),and group W(n=28,all female).According to Dixon's modified se‑quential method,esketamine 0.2 mg/kg was slowly administered to each patient during anesthesia induction,and then ciprofol was ad‑ministered 30 s after injection.The initial dose of ciprofol was set at 0.4 mg/kg and the dose gradient was 0.05 mg/kg,and the dosage of ciprofol in the next patient was determined by Dixon's modified sequential method.Probit regression analysis was used to analyze the ED_(50),95%effective dose(ED_(95)),and 95%confidence interval(CI)of subanesthetic dose of esketamine and ciprofol for gastroenterosco‑py in 3 groups.Mean arterial pressure(MAP),systolic blood pressure(SBP),and diastolic blood pressure(DBP)before anesthesia induction(T_(0))and after administration(T_(1))were recorded and perioperative anesthesia‑related adverse reactions were recorded.Re⁃sults The ED_(50)and 95%CI of ciprofol under subanesthetic doses of esketamine for gastroenteroscopy were:group H was 0.349(0.306~0.387)mg/kg,group M was 0.338(0.262‒0.388)mg/kg while group W was 0.407(0.363‒0.451)mg/kg.The ED_(95)and 95%CI were:group H was 0.427(0.389‒0.655)mg/kg,group M was 0.439(0.389‒0.903)mg/kg,and group W was 0.499(0.454‒0.780)mg/kg.Compared with the group W,the ED_(50)and ED_(95)of ciprofol in group M were low(P<0.05).Compared with T_(0),SBP,DBP,MAP and heart rate in 3 groups decreased at T_(1)(all P<0.05).One patient in group W complained of dizziness,which was relieved after rest,and no ob‑vious nausea,vomiting,or mental problems occurred in the three groups during the recovery period.Conclusions 0.2 mg/kg esket‑amine combined with ciprofol was stable in gastroenteroscopy,which was more suitable for gastroenteroscopy.Compared with males the ED_(50)and ED_(95)were increased by 20.41%and 13.67%,which could guide clinical use.