小剂量艾司氯胺酮对环泊酚用于无痛胃肠镜检查麻醉诱导半数有效剂量的影响

Effects of low-dose esketamine on the median effective dose of ciprofol for anesthesia induction in painless gastrointestinal endoscopy

中文关键词: 艾司氯胺酮  环泊酚  无痛胃肠镜  半数有效剂量  麻醉诱导

英文关键词: Esketamine  Ciprofol  Painless gastrointestinal endoscopy  Median effective dose  Anesthesia induction

中文摘要:

      
目的： 探讨小剂量艾司氯胺酮对环泊酚用于无痛胃肠镜检查麻醉诱导半数有效剂量（ED₅₀）的影响。
方法： 选择择期行无痛胃肠镜检查患者59例，男26例，女33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两组：艾司氯胺酮联合环泊酚组（EC组，n=29）和环泊酚组（C组，n=30）。EC组给予环泊酚前2 min静注艾司氯胺酮0.3 mg/kg，C组于相同时点静注等量生理盐水。麻醉诱导环泊酚初始剂量为0.4 mg/kg，剂量调整梯度为0.04 mg/kg，检查时若出现阳性反应则下一例患者环泊酚诱导剂量增加0.04 mg/kg，阴性反应则下一例患者环泊酚诱导剂量减少0.04 mg/kg。阳性反应为麻醉诱导后2 min患者BIS无法降至60或置入胃镜时出现呛咳或体动反应2级及以上。记录环泊酚总用量、苏醒时间、出室时间、术中及术后不良反应发生情况。采用Probit概率回归分析法计算ED₅₀、95%有效剂量(ED₉₅)和95%可信区间（CI）。
结果： 与C组比较，EC组检查过程中环泊酚总用量、低血压发生率及血管活性药物使用率均明显降低（P<0.05）。EC组使用环泊酚行无痛胃肠镜检查的麻醉诱导ED₅₀为0.21 mg/kg（95%CI 0.12～0.25 mg/kg），ED₉₅为0.32 mg/kg（95%CI 0.26～0.39 mg/kg），C组使用环泊酚行无痛胃肠镜检查的麻醉诱导ED₅₀为0.37 mg/kg（95%CI 0.32～0.40 mg/kg），ED₉₅为0.48 mg/kg（95%CI 0.43～0.54 mg/kg）。与C组比较，EC组使用环泊酚行无痛胃肠镜检查的麻醉诱导ED₅₀、ED₉₅明显降低（P<0.05）。两组其他不良反应发生率差异无统计学意义。
结论： 联合艾司氯胺酮0.3 mg/kg可降低环泊酚用于无痛胃肠镜检查麻醉诱导时的ED₅₀并减少检查过程中环泊酚总用量，术中循环稳定，可安全用于无痛胃肠镜检查。

英文摘要:

      
Objective: To assess the effects of low-dose esketamine on the median effective dose (ED₅₀) of ciprofol for anesthesia induction in painless gastrointestinal endoscopy.
Methods: Fifty-nine patients underwent elective painless gastrointestinal endoscopy, 26 males and 33 females, aged 18-64 years, BMI 18-30 kg/m², ASA physical status Ⅰ or Ⅱ, were divided into two groups by random number table method: esketamine combined with ciprofol group (group EC, n = 29) and ciprofol group (group C, n = 30). Group EC received intravenous injection of esketamine 0.3 mg/kg and group C received the same amount of normal saline 2 minutes before administration of ciprofol. The initial anesthesia induction dose of ciprofol was 0.4 mg/kg. If a positive reaction occurs during the examination, the next patient will receive an increase dose of propofol 0.04 mg/kg, otherwise will decrease by propofol 0.04 mg/kg. The positive reaction was defined that the patient's BIS can not be decreased to 60 2 minutes after anesthesia induction, or the cough or body movement reaction occur at level 2 or above when entering the mirror. The dosage of ciprofol, recovery time, discharge time, the occurrence of intraoperative and postoperative adverse reactions were recorded. The ED₅₀, 95% effective dose (ED₉₅) and 95% confidence interval (CI) of the two groups were calculated by Probit probability regression analysis.
Results: Compared with group C, the dosage of ciprofol, the incidence of hypotension and frequency of administration of vasoactive drugs during the examination process in group EC were significantly reduced (P < 0.05). The ED₅₀ of ciprofol for anesthesia induction in painless gastrointestinal endoscopy in group EC was 0.21 mg/kg (95% CI 0.12-0.25 mg/kg) and the ED₉₅ was 0.32 mg/kg (95% CI 0.26-0.39 mg/kg). The ED₅₀ of ciprofol for anesthesia induction in painless gastrointestinal endoscopy in group C was 0.37 mg/kg (95% CI 0.32-0.40 mg/kg) and the ED₉₅ was 0.48 mg/kg (95% CI 0.43-0.54 mg/kg). The ED₅₀ and ED₉₅ of ciprofol for anesthesia induction in painless gastrointestinal endoscopy in group EC was significantly lower than that in group C (P < 0.05). There was no significant difference in other frequency of adverse events between the two groups.
Conclusion: Esketamine 0.3 mg/kg can reduce the ED₅₀ of ciprofol in painless gastrointestinal endoscopy and reduce the dosage of ciprofol during the examination process, which is safe for painless gastrointestinal endoscopy with stable intraoperative circulation.