邓东香 吴多志

【摘要】目的 探讨艾司氯胺酮联合右美托咪定及利多卡因无阿片化麻醉（OFA）的麻醉诱导抑制气管插管反应的半数有效剂量（ED50）。方法 选择18～59岁、BMI18～30 kg/m?，美国麻醉医师协会分级Ⅰ或Ⅱ级的择期行气管插管全身麻醉手术的成年患者。艾司氯胺酮初始剂量为0.5 mg/kg，使用序贯法，根据气管插管反应决定下一例患者的剂量，相邻剂量的比例为1∶1.1，麻醉诱导采用艾司氯胺酮联合右美托咪定及利多卡因，计算艾司氯胺酮抑制气管插管反应的ED50及其相应的95%CI。结果 共有29例患者被纳入统计分析。气管插管反应阳性（阳性组）15例、反应阴性（阴性组）14例。阳性组共有3例在气管插管过程中出现呛咳反应。艾司氯胺酮抑制气管插管反应的ED50为

0.448 mg/kg，相应的95%CI为0.421～0.476 mg/kg。结论 在进行艾司氯胺酮联合右美托咪定及利多卡因的OFA时，对于抑制气管插管反应，0.448 mg/kg的艾司氯胺酮能引起50%最大反应强度。

【关键词】艾司氯胺酮；无阿片化麻醉；气管插管；半数有效剂量；序贯法

Esketamine combined with dexmedetomidine and lidocaine induced inbition of tracheal intubation response

DENG Dongxiang， WU Duozhi

（Department of Anesthesiology， Hainan Affiliated Hospital of Hainan Medical University（Hainan General Hospital），

Haikou  570311， China）

Corresponding author： WU Duozhi， E-mail： 13976674619@163.com

【Abstract】Objective To investigate the median effective dose （ED50） of esketamine for inhibiting tracheal intubation response during the induction of dexmedetomidine combined with lidocaine under opioid-free anesthesia （OFA）. Methods Adult patients aged 18-59 years with body mass index （BMI）<30 kg/m? and ASA grade Ⅰ or Ⅱ were selected for endotracheal intubation general anesthesia. Dixon sequential method was adopted. The initial dose of esketamine was 0.5 mg/kg， and the dose of the next patient was determined according to the tracheal intubation response. The ratio of adjacent doses was 1∶1.1. The ED50 and 95% confidence interval （CI） of esketamine for inhibiting tracheal intubation response during the induction of dexmedetomidine combined with lidocaine OFA were calculated. Results A total of 29 patients were included for statistical analysis. Tracheal intubation reaction was positive in 15 cases （positive group） and negative in 14 cases （negative group）. In the positive group， 3 cases had cough reaction during tracheal intubation. The ED50 of esketamine for inhibiting tracheal intubation response during the induction of dexmedetomidine combined with lidocaine OFA was 0.448 mg/kg， and the corresponding 95%CI was 0.421-0.476 mg/kg. Conclusion In the OFA of esketamine combined with dexmedetomidine and lidocaine， 0.448 mg/kg of esketamine results in 50% of the maximum response intensity for inhibiting tracheal intubation response.

【Key words】Esketamine； Opioid-free anesthesia； Tracheal intubation； Median effective dose； Sequential method

憑借强大的镇痛作用，阿片类药物可抑制气管插管和手术应激引起的血流动力学反应，但其对人体呼吸、循环及其他重要系统的不良反应直接影响了患者的早期恢复和远期预后［1］，例如呼吸抑制、头晕、嗜睡、恶心、呕吐、急性耐受、痛觉过敏、瘙痒、寒战、尿潴留、肠功能障碍等［2］。这些不良反应延长了患者的住院时间，增加了非正常再入院率，也增加了医疗费用［3］。

近年来，随着加速康复外科（ERAS）理念的普及，为了降低阿片类药物引起的不良反应发生率以及改善患者的预后，无阿片化麻醉（OFA）成为研究热点。……