【罂粟摘要】不同剂量S-氯胺酮与丙泊酚合用在学龄儿童胃十二指肠镜检查中的镇静作用和安全性比较：一项前瞻性随机研究

不同剂量S-氯胺酮与丙泊酚合用在学龄儿童胃十二指肠镜检查中的镇静作用和安全性比较：一项前瞻性随机研究

贵州医科大学  麻醉与心脏电生理课题组

翻译：宋雨婷  编辑：柏雪   审校：曹莹

背景：丙泊酚与阿片类药物合用可减少丙泊酚用量，提高内镜检查的安全性。然而，丙泊酚联合S-氯胺酮用于儿童胃十二指肠镜检查的相关研究较少。本研究旨在确定不同剂量的S-氯胺酮与丙泊酚联合用于学龄儿童胃十二指肠镜检查的镇静作用和安全性。

方法：这是一项前瞻性随机试验。共纳入120名行胃十二指肠镜检查的学龄儿童，随机分为P组，S0.3组、S0.5组和 S0.7组。在诱导过程中，P组、S0.3组、S0.5组和S0.7组分别给予0、0.3 mg/kg、0.5 mg/kg和 0.7 mg/kg  S-氯胺酮，随后再给予3 mg/kg丙泊酚。在胃十二指肠镜检查期间，根据儿童的情况和BIS值（脑电双频谱指数）给予1mg/kg丙泊酚。主要结局指标是首次内镜置入的顺利放置率。次要结局指标是丙泊酚的追加次数、丙泊酚的总量、不良事件发生率、恢复时间、PACU（麻醉后恢复室）滞留时间和内镜医生的满意度。

结果：P组、S0.3组和S0.5组首次内镜置入的顺利放置率明显低于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）追加丙泊酚的次数明显少于P组。S0.7组丙泊酚的总量显著低于P组（P <0.001）。S0.5组和S0.7组术中低血压发生率较低。S0.7组术后头晕的发生率（P =0.003）、PACU滞留时间（P =0.018）和内镜医生满意度（P =0.001）均高于P组。四组之间的恢复时间无差异。

结论：S-氯胺酮（0.7 mg/kg）与丙泊酚合用对接受胃十二指肠镜检查的学龄儿童提供较为满意的镇静效果，并且可以减少丙泊酚的用量，但术后头晕发生率较高，PACU滞留时间较长。

原始文献来源：Wang J, Hu W, Zhao X, Ren W, Huang X, Zhang B. 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. BMC Anesthesiol. 2022;22(1):346. 

英文原文：

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 (0.7mg.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.

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