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| 复合不同剂量艾司氯胺酮时舒芬太尼引起呼吸抑制半数有效剂量的比较 |
| Comparison of combined different doses of esketamine on the median effective dose of sufentanil-induced respiratory depression |
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| DOI：10.12089/jca.2023.09.010 |
| 中文关键词: 艾司氯胺酮 舒芬太尼 呼吸抑制 半数有效剂量 |
| 英文关键词: Esketamine Sufentanil Respiratory depression Median effective dose |
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| 中文摘要: |
目的 比较复合不同剂量艾司氯胺酮时舒芬太尼引起全麻患者呼吸抑制的半数有效剂量（ED50）。
方法 选择2022年2—10月择期行气管插管全麻手术的患者150例，男86例，女64例，年龄20～50岁，BMI 18～24 kg/m2，ASA Ⅰ或Ⅱ级。将患者随机分为三组：A组、B组和C组，每组50例。A组静注咪达唑仑0.03 mg/kg；B组静注咪达唑仑0.03 mg/kg和亚麻醉剂量艾司氯胺酮0.25 mg/kg；C组静注咪达唑仑0.03 mg/kg和麻醉剂量艾司氯胺酮0.5 mg/kg；5 min后三组单次静注舒芬太尼。舒芬太尼单次注射剂量按Dixon序贯法确定，初始剂量0.05 μg/kg，相邻剂量梯度为0.025 μg/kg。若出现呼吸抑制，则下一例患者舒芬太尼降低一个剂量梯度；若未出现呼吸抑制，则下一例升高一个剂量梯度。呼吸抑制标准为SpO2≤92％或RR<10次/分。计算复合不同剂量艾司氯胺酮时舒芬太尼引起呼吸抑制的ED50及95％可信区间（CI）。
结果 A组出现呛咳3例，C组出现HR＞100次/分2例，经相应处理后未影响研究进行。A组、B组和C组达到呼吸抑制时舒芬太尼的ED50及95%CI分别为0.152 μg/kg（95%CI 0.142～0.164 μg/kg）、0.199 μg/kg（95%CI 0.186～0.212 μg/kg）和0.109 μg/kg（95%CI 0.100～0.118 μg/kg）。
结论 咪达唑仑0.03 mg/kg辅助镇静时，单用舒芬太尼静脉注射致呼吸抑制的ED50为0.152 μg/kg；复合艾司氯胺酮0.25 mg/kg可以提高舒芬太尼静脉注射致呼吸抑制的ED50；复合艾司氯胺酮0.5 mg/kg可以降低舒芬太尼静脉注射致呼吸抑制的ED50。 |
| 英文摘要: |
Objective To compare of combined different doses of esketamine on the median effective dose (ED50) of sufentanil-induced respiratory depression in patients undergoing general anesthesia.
Methods A total of 150 patients, 86 males and 64 females, aged 20-50 years, BMI 18-24 kg/m2, ASA physical status Ⅰ or Ⅱ, who were scheduled for elective surgery under general anesthesia were enrolled from February to October 2022. The patients were randomly divided into three groups: group A, group B, and group C, 50 patients in each group. Group A received midazolam 0.03 mg/kg, and group B received intravenous midazolam 0.03 mg/kg and subanesthetic esketamine 0.25 mg/kg, and group C received midazolam 0.03 mg/kg and anesthetic esketamine 0.5 mg/kg. Five minutes later, the three groups received a single intravenous injection of sufentanil. The sufentanil single injection dose was determined by Dixon's up-and-down sequential method, with an initial dose of 0.05 μg/kg and a difference between successive doses of 0.025 μg/kg. If respiratory depression occurred, the dose of sufentanil was reduced by one dose gradient for the next patient. If there was no respiratory depression, the dose was increased by one dose gradient in the next patient. Respiratory depression was defined as SpO2≤ 92% or RR < 10 times per minute. The ED50 and 95% confidence interval (CI) of sufentanil-induced respiratory depression were calculated when combined with different doses of esketamine.
Results Three patients had choking cough in group A and two patients had HR > 100 times per minute in group C, which did not affect the study after corresponding treatment. The ED50 and 95% CI of sufentanil were 0.152 μg/kg (95% CI 0.142-0.164 μg/kg), 0.199 μg/kg (95% CI 0.186-0.212 μg/kg), and 0.109 μg/kg (95% CI 0.100-0.118 μg/kg) in groups A, B and C, respectively.
Conclusion The ED50 of sufentanil-induced respiratory depression by intravenous injection is 0.152 μg/kg when combined with midazolam 0.03 mg/kg. The combined esketamine 0.25 mg/kg can increase the ED50 of sufentanil-induced respiratory depression. The combined esketamine 0.5 mg/kg can reduce the ED50 of sufentanil-induced respiratory depression after intravenous injection. |
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