丙泊酚复合艾司氯胺酮用于全麻的镇静效果

Sedative effect of propofol combined with esketamine using in general anesthesia

中文关键词: 丙泊酚  艾司氯胺酮  半数有效剂量  药效学

英文关键词: Propofol  Esketamine  Half effective dose  Pharmacodynamics

中文摘要:

      
目的 探讨丙泊酚复合艾司氯胺酮用于全麻的镇静效果。
方法 选择择期手术全身麻醉患者150例，男63例，女87例，年龄18～64岁，BMI 18～30 kg/m²，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为三组：丙泊酚组（P组）、艾司氯胺酮组（E组）和丙泊酚复合艾司氯胺酮组（S组），每组50例。每组再随机分为五个亚组，每个亚组10例。在麻醉诱导前，P1组、P2组、P3组、P4组和P5组分别予丙泊酚0.80、1.00、1.25、1.56和1.95 mg/kg，E1组、E2组、E3组、E4组和E5组分别予艾司氯胺酮0.11、0.18、0.30、0.50和0.84 mg/kg，S1组、S2组、S3组、S4组和S5组按照4∶1剂量比分别予丙泊酚/艾司氯胺酮0.38/0.10、0.48/0.12、0.60/0.15、0.75/0.19和0.94/0.24 mg/kg。记录给药5 min内呼吸抑制、高血压、低血压等不良反应发生情况。采用点斜法测定两药及复合用药的半数有效剂量（ED₅₀）和95%可信区间（CI），并用等辐射分析法分析两药复合使用时镇静效应的相互作用。
结果 P组丙泊酚ED₅₀为1.20 mg/kg（95%CI 1.12～1.29 mg/kg），E组艾司氯胺酮ED₅₀为0.30 mg/kg（95%CI 0.25～0.37 mg/kg），S组丙泊酚、艾司氯胺酮ED₅₀分别为0.62 mg/kg（95%CI 0.60～0.64 mg/kg）、0.16 mg/kg（95%CI 0.14～0.18 mg/kg）。等辐射分析法分析后判定丙泊酚与艾司氯胺酮在4∶1剂量比复合使用时为相加作用。
结论 丙泊酚和艾司氯胺酮按4∶1剂量比复合使用时镇静效应为相加作用。

英文摘要:

      
Objective To investigate the interaction of sedative effects of propofol combined with esketamine using in general anesthesia.
Methods A total of 150 patients undergoing general anesthesia, 63 males and 87 females, aged 18-65 years, BMI 18-30 kg/m², ASA physical status Ⅰ or Ⅱ, were selected. The patients were randomly divided into three groups: propofol group (group P), esketamine group (group E), and propofol combined with esketamine group (group S), 50 patients in each group. Each group was randomly divided into five subgroups, 10 patients in each subgroup. Before anesthesia induction, five subgroups P1, P2, P3, P4, and P5 were given propofol 0.80, 1.00, 1.25, 1.56, and 1.95 mg/kg, respectively, and five subgroups E1, E2, E3, E4, and E5 were given esketamine 0.11, 0.18, 0.30, 0.50, and 0.84 mg/kg, respectively. Five subgroups S1, S2, S3, S4, and S5 were given propofol/esketamine 0.38/0.10, 0.48/0.12, 0.60/0.15, 0.75/0.19, and 0.94/0.24 mg/kg according to the dosage ratio of 4∶1, respectively. The occurrence of adverse reactions such as respiratory depression, hypertension and hypotension within 5 minutes of administration were recorded. The median effective dose (ED₅₀) and 95% confidence interval (CI) of the two drugs and the combined drug group were determined by point-slope method, the interaction of sedation effect of the two drugs combined was analyzed by isobolographic analysis.
Results The ED₅₀ of propofol in group P was 1.20 mg/kg (95% CI 1.12-1.29 mg/kg). The ED₅₀ of esketamine in group E was 0.30 mg/kg (95% CI 0.25-0.37 mg/kg). The ED₅₀ of propofol in group S was 0.62 mg/kg (95% CI 0.60-0.64 mg/kg) and the ED₅₀ of esketamine in group S was 0.16 mg/kg (95% CI 0.14-0.18 mg/kg). Isoradiation analysis determined that the combined use of propofol and esketamine at 4∶1 dose ratio was additive.
Conclusion The sedative effect of propofol and esketamine was additive when the dosage ratio was 4∶1.