艾司氯胺酮的镇静效果和安全性

摘要译文

学龄儿童胃十二指肠镜检查中不同剂量S-氯胺酮联合异丙酚的镇静效果和安全性：

一项前瞻性随机研究

背景：
异丙酚联合阿片类药物可减少异丙酚用量，提高内镜检查的安全性。

然而，在接受胃十二指肠镜检查的儿童中，很少有关于异丙酚与S-氯胺酮联合应用的研究。

目的：
我们的目的是在接受胃十二指肠镜检查的学龄儿童中，确定不同剂量的S-氯胺酮联合异丙酚的镇静效果和安全性。

方法：
这是一项前瞻性随机试验。
共有120名接受胃十二指肠镜检查的学龄儿童被随机分为P组、S0.3组、S0.5组和S0.7组。
诱导期间，P组、S0.3组、S0.5组和S0.7组的儿童分别注射0、0.3mg·kg-1，0.5mg·kg-1和0.7mg·kg-1 S-氯胺酮，然后注射3mg·kg-1异丙酚注射液。
胃十二指肠镜检查期间，根据患儿的病情和BIS（双频谱指数）值添加1 mg·kg-1异丙酚注射液。

主要结局指标是第一次内窥镜插入的顺利放置率。
次要结局指标是追加异丙酚的次数、异丙酚的总量、不良事件、恢复时间、PACU（麻醉后监护室）停留时间和内镜医生满意度。

结果：
P组、S0.3组和S0.5组第一次内窥镜插入的顺利率显著低于S0.7组（分别为16.70%、34.50%、50.00%和83.30%，P<0.001）。

S0.3组（P=0.018）、S0.5组（P=0.014）和S0.7组（P=0.001）追加异丙酚的次数明显少于P组。
S0.5组和S0.7组术中低血压的发生率较低。

与P组相比，S0.7组术后头晕的发生率（P=0.003）、PACU停留时间（P=0.018）和内镜医生满意度（P=0.001）显著升高。

各组恢复时间无差异。

结论：
S-氯胺酮（0.7mg·kg-1）联合异丙酚可为学龄儿童胃肠镜检查提供满意的镇静效果，减少异丙酚用量，但术后头晕发生率较高，PACU停留时间较长。

关键词：儿童；胃肠十二指肠镜；异丙酚；S-氯胺酮。

原文摘要
Sedative effect and safety of different doses of S-ketamine in combination with propofol during gastro-duodenoscopy in school-aged children: a prospective, randomized study

Background: Propofol combined with opioids can reduce the dosage of propofol and improve the safety of endoscopy. However, there are few studies on propofol combined with S-ketamine in children undergoing gastro-duodenoscopy. We aim to determine the sedative effect and safety of different doses of S-ketamine in combination with propofol in school-aged children undergoing gastro-duodenoscopy.

Methods: This is a prospective, randomized trial. Totally, 120 school-aged children who underwent gastro-duodenoscopy were randomly allocated into Group P, Group S0.3, Group S0.5 and Group S0.7. During induction, children in Group P, Group S0.3, Group S0.5 and Group S0.7 received 0, 0.3 mg.kg-1, 0.5 mg.kg-1 and 0.7 mg.kg-1 S-ketamine, respectively, following 3 mg.kg-1 propofol injection. During gastro-duodenoscopy, 1 mg.kg-1 of propofol was added according to the condition of the children and the BIS (bispectral index) value. The primary outcome was smooth placement rate of the first endoscope insertion. The secondary outcome was the times of additional propofol, the total amount of propofol, adverse events, recovery time, length of PACU (post anesthesia care unit) stay and endoscopist satisfaction.

Results: The smooth placement rate of the first endoscope insertion in Group P, Group S0.3 and Group S0.5 was significantly lower than that in Group S0.7 (16.70%, 34.50%, 50.00% vs. 83.30%, respectively, P < 0.001). The times of additional propofol in Group S0.3 (P = 0.018), Group S0.5 (P = 0.014) and Group S0.7 (P = 0.001) were significantly less than Group P. The total amount of propofol in Group S0.7 was significantly less than Group P (P < 0.001). The incidence of intraoperative hypotension in Group S0.5 and Group S0.7 was low. Group S0.7 had significantly higher incidence of postoperative dizziness (P = 0.003), longer PACU stay (P = 0.018) and higher endoscopist satisfaction (P = 0.001) than Group P. There was no difference in the recovery time among groups.

Conclusion: S-ketamine (0.7 mg.kg-1) in combination with propofol can provide satisfactory sedative effect and reduce the dosage of propofol in school-aged children undergoing gastro-duodenoscopy, but there are higher incidence of postoperative dizziness and longer PACU stay.

Keywords: Child; Gastro-duodenoscopy; Propofol; S-ketamine.