【罂粟摘要】持续静脉输注氯胺酮和丙泊酚用于重症监护室长时间镇静：一项前瞻性观察研究

持续静脉输注氯胺酮和丙泊酚用于重症监护室长时间镇静：一项前瞻性观察研究

贵州医科大学    麻醉学与心脏电生理课题组

翻译：文春雷         编辑：宋雨婷        审校：曹莹

引言

镇痛和镇静是儿科重症监护的重要治疗。联合使用氯胺酮和异丙酚可用于需要长期镇静或镇静困难的患者，并能够减少苯二氮卓类药物和阿片类药物的使用。本研究的目的是评估儿科重症监护室中持续输注氯胺酮和异丙酚延长患儿镇痛/镇静的有效性和安全性。

方法

本试验为一项前瞻性、观察性单组队列研究，于2016年至2018年纳入接受氯胺酮和异丙酚持续输注且年龄为1个月至16岁的儿科重症监护病房患者。本试验收集了人口统计学和临床特征、镇痛和镇静评分（MAPS、COMFORT-B和SOPHIA）、血流动力学参数和不良事件数据。

结果

该研究包括32例患者。氯胺酮的最大剂量为1.5mg/kg/h（四分位数范围[IQR]，1-2mg/kg/h），输注时间为5天（IQR，3-5天）。异丙酚的最大剂量为3.2 mg/kg/h（IQR，2.5-3.6 mg/kg/h），输注时间为5天(IQR，3-5天）。30例（93.7%）患者曾接受过咪达唑仑治疗，29例（90.6%）患者曾接受过芬太尼治疗。在氯胺酮和异丙酚输注后，镇痛评分无变化。COMFORT-B评分有统计学意义，但仍在合适的镇静范围内(12-17）。平均动脉压有轻微下降，但有统计学意义（从64 mmHg降至60 mmHg；P =0.006)。氯胺酮和异丙酚输注1小时后舒张压下降（50.5-48mmHg；P =0.023），但12小时后未观察到这种差异，不需要给予血管活性药物。在输注过程中未发现其他严重不良事件。

结论

氯胺酮和异丙酚联合持续输注是治疗危重患儿的一种安全治疗方法，可在没有相关血流动力学影响的情况下达到适当的镇痛和镇静水平。

原始文献来源：

Laura Torres Soblechero, Doris Elena Ocampo Benegas, Gema Manrique Martín,et al.Prospective observational study on the use of continuous intravenous ketamine and propofol infusion for prolonged sedation in critical care.[J].Available ,2023:276–282.

英文原文

Prospective observational study on the use of continuous intravenous ketamine and propofol infusion for prolonged sedation in critical care

Introduction: Analgesia and sedation are a priority in paediatric intensive care. The combination of ketamine and propofol is a possible option in patients requiring prolonged or difficult sedation and to reduce the use of benzodiazepines and opiates. The aim of this study was to assess the efficacy and safety of combination ketamine and propofol in continuous infusion for prolonged analgesia/sedation in the paediatric intensive care setting.

Patients and methods: Prospective, observational single-group cohort study in patients aged 1 month to 16 years admitted to the paediatric intensive care unit in 2016---2018 that received ketamine and propofol in continuous infusion for analgesia and sedation. We collected data on demographic and clinical characteristics, analgesia and sedation scores (MAPS, COMFORT-B and SOPHIA), haemodynamic parameters and adverse events.

Results: The study included 32 patients. The maximum dose of ketamine was 1.5 mg/kg/h (interquartile range [IQR], 1−2 mg/kg/h) and the infusion duration was 5 days (IQR, 3---5 days). The maximum dose of propofol was 3.2 mg/kg/h (IQR, 2.5---3.6 mg/kg/h) and the infusion duration, 5 days (IQR, 3---5 days). Thirty (93.7%) patients had previously received midazolam and 29(90.6%) fentanyl. Analgesia scores did not change after initiation of the ketamine and propofol infusion. There was a statistically significant increase in the COMFORT-B score, but the score remained in the adequate sedation range (12---17). There were small but statistically significant decreases in the mean arterial pressure (from 64 mmHg to 60 mmHg; P = .006) and the diastolic blood pressure (from 50.5 to 48 mmHg; P = .023) 1 h after the initiation of the ketamine and propofol infusion, but this difference was not observed 12 h later and did not require administration of vasoactive drugs. No other major adverse events were detected during the infusion.

Conclusions: The combination of ketamine and propofol in continuous infusion is a safe treatment in critically ill children that makes it possible to achieve an appropriate level of analgesia and sedation without relevant haemodynamic repercussions.