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| 艾司氯胺酮在无痛人工流产术中的临床应用 |
| Clinical application of escloamine in painless induced abortion |
| 投稿时间：2022-02-08 |
| DOI：10.3969/j.issn.1000-0399.2023.02.005 |
| 中文关键词: 艾司氯胺酮 半数有效剂量 无痛人工流产 体动反应 |
| 英文关键词: Esketamine Half effective dose Painless induced abortion Body motion reaction |
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| 中文摘要: |
| 目的 采用改良序贯测定艾司氯胺酮抑制无痛人工流产术体动反应的半数有效剂量(ED50),并观察艾司氯胺酮在无痛人工流产术中的临床应用效果和不良反应。方法 选取2021年9月至2021年11月在延安市人民医院择期行无痛人工流产术且ASA I~Ⅱ级的26例患者。采用改良序贯法操作,艾司氯胺酮的初始剂量为0.3 mg/kg,相邻患者剂量差0.05 mg/kg,若上一例患者术中发生体动反应(扭臀、抬手、动腿)影响手术操作为阳性,则下一例患者增加0.05 mg/kg,反之减少0.05 mg/kg,直至出现7个拐点结束研究。计算艾司氯胺酮抑制体动反应的ED50、ED95及95%可信区间(CI),记录苏醒时间、苏醒后5 min视觉模拟评分法(VAS)疼痛评分,记录低血压、呼吸抑制(SpO2＜90%)、术后谵妄、恶心呕吐、分泌物增加等不良反应发生情况。结果 艾司氯胺酮抑制人工流产手术体动反应的ED50为0.294(95% CI:0.256~0.332) mg/kg,ED95为0.370(95% CI:0.332~0.590) mg/kg,苏醒时间(11.3±1.2) min,苏醒后5 min VAS评分(1.3±0.6)分,所有患者未发生低血压、术后谵妄、苏醒期躁动,1例发生呼吸抑制,1例发生恶心,5例患者出现口腔分泌物增加。结论 丙泊酚静脉麻醉时,艾司氯胺酮抑制无痛人工流产手术术中体动反应的ED50及95% CI为0.294(0.256~0.332) mg/kg,不良反应少,苏醒质量高。 |
| 英文摘要: |
| Objective To observe the clinical effect and adverse reactions of esticketamine in painless induced abortion by modified sequential determination of half effective dose (ED50) of esticketamine in inhibiting body motor reaction. Methods From September 2021 to November 2021, 26 patients with ASA Ⅰ~Ⅱ grade underwent elective painless induced abortion in Yan ’an People’s Hospital were selected. Using the modified sequential method, the initial dose of esticketamine was 0.3 mg/kg, and the dose difference between the adjacent patients was 0.05 mg/kg. If the body movement reaction (hip movement, hand lifting, leg movement) occurred during the operation of the previous patient was positive, the next patient would be increased 0.05 mg/kg, otherwise decreased 0.05 mg/kg. The study ended at seven inflection points. The ED50, ED95 and 95% confidence interval (CI) of esketamine inhibition of body motor response were calculated. The time of awakening, visual analogue scale (VAS) pain score 5 min after awakening, hypotension, respiratory depression (SpO2 <90%), postoperative vision, nausea and vomiting, increased secretions and other adverse reactions were recorded. Results The ED50 were 0.294 (95%CI:0.256~0.332) mg/kg, ED95 were 0.370 (95%CI:0.332~0.590) mg/kg, and the time to wake up was (11.3±1.2) min. Vas score at 5min after awakening was (1.3±0.6). None of the patients had hypotension, postoperative vision or agitation during awakening, 1 patient had respiratory depression, 1 patient had nausea, and 5 patients had increased oral secretions. Conclusions The ED50 and 95%CI of esketamine for inhibiting intraoperative motor reaction of painless induced abortion during propofol intravenous anesthesia were 0.294(0.256~0.332) mg/kg, indicating less adverse reactions and higher quality of recovery. |
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