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目的 探讨艾司氯胺酮对丙泊酚抑制小儿骶管穿刺时体动反应半数有效剂量(ED50)的影响。方法 选取2023年4至10月择期手术中需要骶管阻滞患儿48例，采用随机数字表法分为艾司氯胺酮联合丙泊酚(E+P)组和0.9%氯化钠注射液联合丙泊酚(NS+P)组，每组24例。两组首例患儿静脉给予丙泊酚2.5 mg/kg后，E+P组静脉推注0.5 mg/kg艾司氯胺酮，NS+P组静脉推注等量0.9%氯化钠注射液。采用Dixon改良序贯法测定丙泊酚诱导剂量，在患儿警觉/镇静评分≤1分时行超声引导下骶管阻滞。记录两组丙泊酚的诱导剂量、骶管阻滞时间，监测患儿入室平静时(T0)、给药后1 min(T1)、骶管阻滞穿刺即刻(T2)平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(SpO2)及静脉注射痛、心动过速等不良事件发生情况。结果 与NS+P组比较，E+P组丙泊酚诱导的ED50、95%有效剂量明显降低(P<0.05)。与NS+P组比较，E+P组在T1和T2时MAP、HR明显增加(P<0.01)。与T0时比较，E+P组T1、T2时MAP、HR有明显增加(P<0.05)；与T0时比较，NS+P组T1、T2时MAP、HR有明显降低(P<0.05)；与T0时比较，E+P组T1、T2时SpO2有明显下降(P<0.05)；与T0时比较，NS+P组T1、T2时SpO2有明显下降(P<0.05)。E+P组丙泊酚注射痛发生率为33.3%(8/24)明显低于NS+P组的75.0%(18/24)，差异有统计学意义(P<0.05)。两组均未见明显不良反应发生。结论 静脉推注0.5 mg/kg艾司氯胺酮可显著降低丙泊酚抑制骶管穿刺患儿骶管阻滞时ED50，还可以降低丙泊酚注射痛发生率，而不显著影响患儿血流动力学。
Abstract：Objective To investigate the effect of Esketamine on the median effective dose(ED50) of Propofol for inhibiting body movement response during pediatric caudal block. Methods We selected forty-eight children scheduled for elective surgery and requiring caudal block from April to October 2023. Using the random number table method, patients were divided into the Esketamine combined with Propofol(E+P) group and the 0.9% Sodium Chloride injection combined with Propofol(NS+P) group, with 24 patients in each group. After intravenous administration of 2.5 mg/kg Propofol to the first patient in the two groups, the E+P group received intravenous injection of 0.5 mg/kg Esketamine, while the NS+P group received intravenous injection of an equal amount of 0.9% Sodium Chloride injection. Propofol induction dose was determined using the Dixon modified sequential method. Caudal block was performed under ultrasound guidance when Obeserver's assessment of alertness/sedation(OAA/S) score of patients was ≤1. The Propofol induction doses and time required for caudal block of the two groups were recorded. Mean arterial pressure(MAP), heart rate(HR), and pulse oxygen saturation(SpO2) of the children were monitored upon entering the operating room in a calm state(T0), at 1 min after drug administration(T1), and immediately after the initiation of caudal block puncture(T2), and incidents of adverse events such as injection pain and tachycardia were also recorded. Results Compared with the NS+P group, the ED50 and ED95 of Propofol induction in the E+P group were significantly reduced(P<0.05). Compared with the NS+P group, the E+P group showed significantly increased MAP and HR at T1 and T2(P<0.05), and compared with those at T0, the E+P group had significantly increased MAP and HR at T1 and T2(P<0.05). Compared with those at T0, the NS+P group had significantly decreased MAP and HR at T1 and T2(P<0.05), the E+P group had significantly decreased SpO2 at T1 and T2(P<0.05), and the NS+P group also had significantly decreased SpO2 at T1 and T2(P<0.05). The incidence of Propofol injection pain in the E+P group was 33.3%(8/24), which was significantly lower than that in the NS+P group(75.0%, 18/24), with a significant difference(P<0.05). No obvious adverse reactions were observed in either group. Conclusion Intravenous injection of 0.5 mg/kg Esketamine can significantly reduce the ED50 of Propofol required for caudal block in children during caudal puncture, and also reduce the incidence of Propofol injection pain without significantly affecting the children's hemodynamics.
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基本信息:
中图分类号:R726.1
引用信息:
[1]杜冰,吴小乐,王瑞玉,等.艾司氯胺酮对丙泊酚抑制小儿骶管穿刺时体动反应半数有效剂量的影响[J].临床误诊误治,2025,38(23):121-127.
基金信息:
徐州市卫生健康委科技面上项目（XWKYHT20220072）; 徐州市儿童医院院课题（23040401）
2025-05-08
2025
2025-11-03
2025-12-30
2025
1
2025-12-13
2025-12-13