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| 昼夜节律对艾司氯胺酮镇静效果的影响 |
| Effect of circadian rhythm on esketamine sedation |
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| DOI：10.12089/jca.2021.08.005 |
| 中文关键词: 昼夜节律 艾司氯胺酮 剂量-效应关系 |
| 英文关键词: Circadian rhythm Esketamine Dose-response relationship |
| 基金项目:国家自然科学基金面上项目（81971020） |
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| 摘要点击次数: 2706 |
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| 中文摘要: |
目的 比较日间与夜间使用艾司氯胺酮镇静达到意识消失时的用量，探讨昼夜节律对艾司氯胺酮镇静效果的影响，并计算日间与夜间镇静的半数有效剂量（ED50）。
方法 选择择期全身麻醉下行泌尿外科手术的男性患者100例，年龄18～65岁，BMI 18.5~30.0 kg/m2 ASA Ⅰ或Ⅱ级，根据全身麻醉诱导开始时间分为两组：日间组（08：00至18：00）和夜间组（20：00至次日06：00），每组50例。每组按随机数字表法分为0.30、0.35、0.41、0.48、0.57 mg/kg五个等比剂量亚组，每亚组10例。以达到Ramsay评分6级为意识消失标准；采用Probit回归法计算日间组和夜间组的ED50和ED95及其95%CI。
结果 日间组意识消失时艾司氯胺酮使用剂量为（0.422±0.070）mg/kg，明显高于夜间组（0.361±0.092）mg/kg（P<0.05）；日间组ED50为（0.402 mg/kg，95%CI 0.370～0.442 mg/kg），ED95为（0.519 mg/kg，95%CI 0.470～0.649 mg/kg）；夜间组ED50为（0.360 mg/kg，95%CI 0.316～0.394 mg/kg）、ED95为（0.479 mg/kg，95%CI 0.432～0.618 mg/kg）。
结论 昼夜节律性变化影响艾司氯胺酮的镇静效应，夜间使用艾司氯胺酮的镇静效果更强。 |
| 英文摘要: |
Objective To compare the dose of esketamine when consciousness disappeared during daytime and nighttime, explore the effect of circadian rhythms on the sedative effect of esketamine, and calculate the daytime and nighttime median effective dose (ED50) for sedation of esketamine.
Methods One hundred male patients, aged 18-65 years, BMI 18.5-30.0 kg/m2, ASA physical status Ⅰ or Ⅱ, scheduled for elective grade Ⅰ or Ⅱ urological surgery were divided into two groups (n = 50) according to the hour of the day when they received general anesthesia induction: daytime group (8:00 to 18:00) and nighttime group (20:00 to next day 6:00). Each group was divided into 5 subgroups (n=10) by random number table method to received dose of 0.30, 0.35, 0.41, 0.48 and 0.57 mg/kg of esketamine intravenous bolus, respectively. Ramsay score was used as the standard for consciousness disappearance. Probit regression method was used to calculate the ED50 and ED95 of daytime group and nighttime group.
Results When consciousness disappeared, the dose was (0.422 ± 0.070) mg/kg of esketamine in the daytime group, which higher than that in nighttime group was (0.361 ± 0.092) mg/kg, with statistically significant differences (P < 0.05). The ED50 and ED95 of daytime group were 0.402 mg/kg (95% CI 0.370-0.422 mg/kg) and 0.519 mg/kg (95% CI 0.470-0.649 mg/kg), respectively. The ED50 and ED95 of nighttime group were 0.36 mg/kg (95% CI 0.316-0.394 mg/kg) and 0.479 mg/kg (95% CI 0.432-0.618 mg/kg), respectively.
Conclusion The sedative effect of esketamine is correlated with the circadian rhythm; the sedative effect of esketamine is more powerful at night. |
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