文章摘要
小剂量艾司氯胺酮对依托咪酯用于老年患者无痛胃镜检查麻醉诱导半数有效剂量的影响
Effect of low-dose esketamine on median effective dose of etomidate for anesthetic induction in elderly patients undergoing painless gastroscopy
  
DOI：10.12089/jca.2026.02.002
中文关键词: 艾司氯胺酮  依托咪酯  无痛胃镜  半数有效剂量  老年
英文关键词: Esketamine  Etomidate  Painless gastroscopy  Median effective dose  Aged
基金项目:安徽省高校科学研究基金（2022AH051187）；安徽省转化医学研究院科研基金（2023zhyx-C61）；安徽医科大学校科研基金（2022xkj140，2022xkj148）
作者单位E-mail
郭培培 230022,合肥市,安徽医科大学第一附属医院麻醉科  
程俊 230022,合肥市,安徽医科大学第一附属医院麻醉科  
代文龙 230022,合肥市,安徽医科大学第一附属医院麻醉科  
吴晋杰 230022,合肥市,安徽医科大学第一附属医院麻醉科  
吴会生 230022,合肥市,安徽医科大学第一附属医院麻醉科 yfy1022666@fy.ahmu.edu.cn 
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中文摘要:
      
目的：探讨小剂量艾司氯胺酮对依托咪酯用于老年患者无痛胃镜检查麻醉诱导半数有效剂量（ED50）的影响。
方法：选择择期行无痛胃镜检查的老年患者，年龄65～80岁，ASAⅠ或Ⅱ级。采用随机数字表法将患者分为两组：艾司氯胺酮联合依托咪酯组（S组）和依托咪酯组（E组）。静脉注射舒芬太尼0.06 μg/kg后，S组给予艾司氯胺酮0.2 mg/kg，E组给予等量生理盐水。根据改良Dixon序贯法确定依托咪酯镇静诱导的给药剂量。依托咪酯初始诱导剂量设定为0.2 mg/kg，剂量调整梯度为0.02 mg/kg。若在置入胃镜时患者有呛咳、体动等影响操作的反应被定义为阳性反应，累计出现7个阳性-阴性反应交叉点时停止试验。主要指标为依托咪酯诱导的半数有效剂量（ED50）。次要指标包括依托咪酯总量、胃镜诊疗时间、睁眼时间、定向力恢复时间、PACU滞留时间及围术期不良反应发生情况。采用Probit概率回归分析法确定依托咪酯的ED50、95%有效剂量（ED95）和95%可信区间（CI）。
结果：共纳入老年患者68例，S组35例，E组33例。S组依托咪酯抑制胃镜插入反应的ED50为0.169 mg/kg（95%CI 0.141～0.194 mg/kg），ED95为0.231 mg/kg（95%CI 0.201～0.444 mg/kg），E组的ED50为0.226 mg/kg（95%CI 0.203～0.252 mg/kg），ED95为0.281 mg/kg（95%CI 0.254～0.481 mg/kg）。与E组比较，S组依托咪酯抑制胃镜置入反应的ED50、ED95明显减少，依托咪酯总量、低血压、呼吸抑制及肌阵挛发生率明显降低（P＜0.05）。两组胃镜诊疗时间、睁眼时间、定向力恢复时间、恢复室滞留时间等差异无统计学意义。
结论：艾司氯胺酮0.2 mg/kg可有效降低老年患者行无痛胃镜检查时依托咪酯抑制胃镜置入反应的ED50和ED95，并减少依托咪酯总剂量及肌阵挛的发生率，术中呼吸循环稳定，可安全用于老年患者无痛胃镜检查。
英文摘要:
      
Objective: To investigate the effect of low-dose esketamine on the median effective dose(ED50)of etomidate for anesthesia induction in elderly patients undergoing painless gastroscopy.
Methods: Elderly patients aged 65-80 years, ASA physical status Ⅰ or Ⅱ, scheduled for elective painless gastroscopy were selected. Patients were randomly divided into two groups using a random number table: the esketamine combined with etomidate group (group S) and the etomidate group (group E). After intravenous injection of sufentanil 0.06 μg/kg, group S received esketamine 0.2 mg/kg, while group E received an equivalent volume of normal saline. The induction dose of etomidate was determined using the modified Dixon's up-and-down sequential method. The initial induction dose of etomidate was set at 0.2 mg/kg, with a dose adjustment gradient of 0.02 mg/kg. A positive response was defined as the occurrence of coughing, body movement, or other reactions affecting the procedure during gastroscope insertion. The study concluded when seven positive-negative response crossover points were recorded. The primary outcome was the ED50 of etomidate for induction. Secondary outcomes included the total dose of etomidate, gastroscopy procedure time, eye-opening time, time to recovery of orientation, PACU stay time, and the incidence of perioperative adverse events. Probit regression analysis was used to calculate the ED50, 95% effective dose (ED95), and 95% confidence intervals (CI) of etomidate.
Results: Sixty-eight elderly patients were enrolled in this study, 35 patients in group S and 33 patients in group E. In group S, the ED50 of etomidate for suppressing the response to gastroscope insertion was 0.169 mg/kg (95% CI 0.141-0.194 mg/kg), and the ED95 was 0.231 mg/kg (95% CI 0.201-0.444 mg/kg). In group E, the ED50 was 0.226 mg/kg (95% CI 0.203-0.252 mg/kg), and the ED95 was 0.281 mg/kg (95% CI 0.254-0.481 mg/kg). Compared with group E, the ED50 and ED95 of etomidate for suppressing the response to gastroscope insertion were significantly reduced in group S. The total dose of etomidate, and the incidences of hypotension, respiratory depression, and myoclonus were also significantly lower in group S (P < 0.05). There were no statistically significant differences between the two groups in gastroscopy time, eye-opening time, time to recovery of orientation, or PACU stay time.
Conclusion: Esketamine 0.2 mg/kg can effectively reduce the ED50 and ED95 of etomidate required to suppress the response to gastroscope insertion in elderly patients undergoing painless gastroscopy. It also reduces the total dose of etomidate and the incidences of myoclonus, while maintaining stable respiratory and circulatory function during the procedure, making it a safe option for painless gastroscopy in elderly patients.
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