郑州大学学报（医学版）2025，Vol.60Issue(2)：241-245,5.DOI:10.13705/j.issn.1671-6825.2024.08.087
不同剂量艾司氯胺酮复合丙泊酚在儿童纤维支气管镜检查深度镇静中的应用效果
Application of different doses of esketamine combined with propofol for deep sedation in pediatric fiberoptic bronchoscopy
摘要
Abstract
Aim:To explore the efficacy of different doses of esketamine combined with propofol for deep sedation in pediatric fiberoptic bronchoscopy.Methods:Children aged 6-12 undergoing fiberoptic bronchoscopy were selected and di-vided into 4 groups:the propofol group(propofol alone for sedation)and the low-,medium-,and high-dose esketamine groups(0.15,0.30,and 0.45 mg/kg esketamine combined with propofol,respectively).The Dixon modified sequential method was used to determine the propofol dosage,with an initial induction dose of 3.0 mg/kg and a dose gradient of 0.3 mg/kg between adjacent patients.If consciousness was lost,the dose for the next patient was decreased by one gradient;oth-erwise,it was increased by one gradient.The procedure was terminated after 7 crossover points,and sedation was maintained with propofol at 4-8 mg/(kg·h).The median effective dose(ED50)of propofol was calculated using the Probit probabili-ty method.The total propofol dosage,induction time,procedure time,recovery time,and incidence of adverse events were re-corded.The pediatric anesthesia emergence delirium(PAED)score and the incidence of postoperative delirium were as-sessed 10 minutes after full recovery.Results:A total of 97 children were included,with 24 in the propofol group and 24,24,and 25 in the low-,medium-,and high-dose esketamine groups,respectively.The ED50(95％CI)of propofol for loss of consciousness in the propofol group and the low-,medium-,and high-dose esketamine groups were 2.543(2.371-2.691)mg/kg,2.409(2.199-2.585)mg/kg,2.250(2.074-2.419)mg/kg,and 2.011(1.679-2.223)mg/kg,respectively.Compared with the propofol group and the low-dose ketamine group,the induction time of the medium and high-dose esket-amine groups was reduced(P＜0.05);compared with the propofol group,the incidence of apnea and hypoxia was reduced in the high-dose esketamine group,while the total dose of propofol was reduced,and the incidence of mask compression ven-tilation and injection pain was reduced,the PAED score and the incidence of delirium during the recovery period were in-creased(P＜0.05);compared with the low-dose esketamine group,the high-dose esketamine group had a lower incidence of apnea and injection pain(P＜0.05).Conclusion:In deep sedation for pediatric fiberoptic bronchoscopy,increasing the dose of esketamine reduces the ED50 of propofol and the incidence of respiratory-related adverse events but increases the risk of postoperative delirium.The combination of 0.30 mg/kg esketamine with propofol achieves the lowest incidence of respira-tory-related adverse events and postoperative delirium,making it an optimal choice for pediatric sedation in this context.关键词
艾司氯胺酮/丙泊酚/儿童/纤维支气管镜检查/量效关系Key words
esketamine/propofol/children/fiberoptic bronchoscopy/dose-effect relationship分类
医药卫生引用本文复制引用
王凯利,王志涛,李治松..不同剂量艾司氯胺酮复合丙泊酚在儿童纤维支气管镜检查深度镇静中的应用效果[J].郑州大学学报（医学版）,2025,60(2):241-245,5.基金项目
河南省医学科技攻关计划联合共建项目(20220493) （20220493）
