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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:

35

期数:

2018年1

页码:

057-60

栏目:

临床研究

出版日期:

2018-01-05

文章信息/Info

Title:

Effect of ketamine and sufentanyl on respiratory depression induced by propofol in pediatric patients

作者:

董正华; 魏晓永; 李　黎; 吴艳玲; 王　涛; 姜丽华

（郑州大学第三附属医院麻醉科，河南　郑州　450052）

Author(s):

DONG Zheng-hua; WEI Xiao-yong; LI Li; WU Yan-ling; WANG Tao; JIANG Li-hua

（Department of Anesthesia，the Third Affiliated Hospital of Zhengzhou University，Zhengzhou 450052，Henan Province，China）

关键词:

小儿麻醉; 氯胺酮; 舒芬太尼; 丙泊酚; 呼吸抑制; 半数有效浓度

Keywords:

pediatric anesthesia; ketamine; sufentanil; propofol; respiratory depression; median effective concentration

分类号:

R726.1

DOI:

10.7683/xxyxyxb.2018.01.014

文献标志码:

A

摘要:

目的　比较氯胺酮与舒芬太尼对丙泊酚诱发小儿呼吸抑制的影响。方法　选择2014年2月至2015年8月郑州大学第三附属医院小儿骨科收治的马蹄足患儿60例，根据麻醉方法分为氯胺酮组、舒芬太尼组和对照组，每组20例。氯胺酮组患儿静脉注射氯胺酮1.50 mg·kg^-1后，泵注氯胺酮0.75 mg·kg^-1·h^-1维持；舒芬太尼组患儿静脉注射舒芬太尼0.2 μg·kg^-1后，泵注舒芬太尼0.1 μg·kg^-1·h^-1维持；对照组患儿静脉输注等量生理盐水。氯胺酮组、舒芬太尼组和对照组患儿丙泊酚初始血浆靶浓度为1.1 mg·L^-1，相邻浓度梯度比为1.1，当患儿出现呼吸抑制时为阳性反应。记录3组患儿开始静脉输注氯胺酮或舒芬太尼时（T₁）、丙泊酚靶控输注（TCI） 3 min（T₂）、5 min（T₃）及效应室浓度与血浆靶浓度平衡时（T₄） 脑电双频谱指数（BIS）和观察者警觉/镇静（OAA/S）评分；当BIS降至65或OAA/S评分达3分时，记录此时丙泊酚的效应室浓度；计算丙泊酚诱发患儿呼吸抑制的半数有效浓度（EC₅₀）及其95%可信区间（CI）。结果　T₁时3组患儿BIS和OAA/S评分比较差异均无统计学意义（P>0.05），T₂、T₃、T₄时氯胺酮组和舒芬太尼组患儿BIS和OAA/S评分均较对照组降低（P<0.05），且氯胺酮组患儿在T₂、T₃、T₄时BIS和OAA/S评分较舒芬太尼组降低（P<0.05）。氯胺酮组、舒芬太尼组和对照组患儿丙泊酚诱发呼吸抑制的EC₅₀及其95% CI分别为1.75（1.56～2.34）、1.86（1.47～2.23）、2.82（2.56～3.02）mg·L^-1，氯胺酮组和舒芬太尼组患儿丙泊酚诱发呼吸抑制的EC₅₀均显著低于对照组（P<0.05），但氯胺酮组和舒芬太尼组患儿丙泊酚诱发呼吸抑制的EC₅₀比较差异无统计学意义（P>0.05）。结论　氯胺酮与舒芬太尼均可降低小儿丙泊酚泵入时呼吸抑制的EC₅₀，但二者效力无显著差异；氯胺酮与舒芬太尼可降低丙泊酚的BIS及OAA/S评分，增强丙泊酚的镇静效能，且氯胺酮强于舒芬太尼。

Abstract:

Objective　To compare the effect of ketamine and sufentanyl on respiratory depression induced by propofol in pediatric patients.Methods　Sixty children with taplipes equines in the Department of Pediatric Orthopedics，the Third Affiliated Hospital of Zhengzhou University from February 2014 to August 2015 were selected and divided into ketamine group，sufentanil group and control group，with 20 patients in each group.The patients in ketamine group were given ketamine 1.50 mg·kg^-1 by intravenous injection and maintained with ketamine 0.75 mg·kg^-1·h^-1 by pump infusion；the patients in sufentanil group were given sufentanil 0.2 μg·kg^-1 by intravenous injection and maintained with sufentanil 0.1 μg·kg^-1·h^-1 by pump infusion；the patients in control group were given the same volume of saline.The initial plasma concentration of propofol in ketamine group，sufentanil group and control group was 1.1 mg·L^-1，and the ratio between the two successive concentration gradients was 1.1.It was defined as positive when patients developed respiration depression.The bispectral index （BIS） and the observer′s assessment of alertness/sedation （OAA/S） score of patients in the three groups were recorded at the time point of intravenous infusion ketamine or sufentanil （T₁），3 min after propofol target controlled infusion （TCI） （T₂），5 min after propofol TCI （T₃） and after the target effect-site and plasma concentrations were balanced（T₄）.The target effect-site concentration was recorded when the BIS dropped to 65 or OAA/S score was 3.The median effective concentration（EC₅₀） and its 95% confidence interval （CI） of propofol inducing respiratory depression were calculated.Results　There was no statistic difference in BIS and OAA/S scores of patients at the time point of T₁ among the three group（P>0.05）；the BIS and OAA/S scores of patients in ketamine group and sufentanil group were significantly lower than those in the control group at the time point of T₂，T₃ and T₄ （P<0.05）；the BIS and OAA/S scores of patients in ketamine group were significantly lower than those in the sufentanil group at the time point of T₂，T₃，T₄ （P<0.05）.The EC₅₀ and its 95% CI of respiratory depression induced by propofol in ketamine group，sufentanil group and the control group were 1.75 （1.56-2.34），1.86 （1.47 -2.23），2.82 （2.56-3.02） mg·L^-1 respectively.The EC₅₀ of patients in ketamine group and sufentanil group was significantly lower than that in control group （P<0.05），but there was no statistic difference in EC₅₀ of patients between the ketamine group and sufentanil group （P>0.05）.Conclusion　Both ketamine and sufentanil can increase the EC₅₀ of respiratory depression induced by propofol in pediatric patients，but the effects of both drugs are the same.Ketamine and sufentanil can reduce the BIS and OAA/S scores of patients，enhance the sedation efficacy of propofol，and the effect of ketamine is better than sufentanil.

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更新日期/Last Update: 2018-01-05