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异丙酚-艾斯氯胺酮与异丙酚-舒芬太尼用于自闭症儿童深度镇静镇痛的比较:一项随机双盲临床试验
贵州医科大学 麻醉与心脏电生理课题组
翻译：王婷婷 编辑：王婷婷 审校：曹莹
背景：异丙酚镇静通常用于内窥镜手术，对儿童是安全且可接受的。辅助剂如艾斯氯胺酮或舒芬太尼，通常被添加以提高异丙酚镇静的有效性和安全性。
目的：本研究旨在比较异丙酚-艾斯氯胺酮(PE)与异丙酚-舒芬太尼(PS)在自闭症儿童结肠镜手术中深度镇静镇痛的临床疗效和安全性。
方法与结果：124名接受结肠镜检查的自闭症儿童参与了这项研究。患者被随机分配接受两种佐剂之一:艾斯氯胺酮(0.3 mg/kg)或舒芬太尼(0.2 μg/kg)，随后给予异丙酚2.0 mg/kg诱导麻醉。根据需要给予额外剂量的异丙酚(0.5-1.0 mg/kg)，以确保患者在手术剩余时间内的耐受性。记录手术过程中的运动、血流动力学变量、异丙酚总剂量、恢复时间和不良事件。与PS组相比，PE组在手术过程中出现严重运动的发生率明显降低(14.52% vs. 32.26%， p = 0.020)。PE组术中呼吸抑制、低血压、异丙酚严重注射痛发生率明显低于PS组(均p < 0.05)。PS组麻醉诱导后平均动脉压(MAP)明显降低，仍低于基线(p < 0.05)。
结论：与低剂量舒芬太尼(0.2 μg/mg)与异丙酚联用相比，低剂量艾斯氯胺酮(0.3 mg/kg)与异丙酚联用对自闭症儿童结肠镜检查的血流动力学更稳定，镇静质量更高，不良事件更少。
原始文献来源：Miao Y, Zheng M, Li Q, et al. Comparison of propofol-esketamine versus propofol-sufentanil for deep sedation and analgesia in children with autism: A randomized double-blind clinical trial. Autism Res. Published online June 8, 2024. doi:10.1002/aur.3172
Comparison of propofol-esketamine versus propofol-sufentanil for deep sedation and analgesia in children with autism: A randomized double-blind clinical trial
Propofol sedation, routinely used for endoscopic procedures, is safe and acceptable for children. Adjuvants, such as esketamine or sufentanil, are commonly added to improve the efficacy and safety of propofol sedation. This study aimed to compare the clinical efficacy and safety of propofol-esketamine (PE) versus propofol-sufentanil (PS) for deep sedation and analgesia in children with autism undergoing colonoscopy procedure. One hundred and twenty-four children with autism undergoing colonoscopy procedure were included in the study. Patients were randomly assigned to receive one of the two adjuvants: esketamine (0.3 mg/kg) or sufentanil (0.2 μg/kg), subsequently administered propofol 2.0 mg/kg to induce anesthesia. Additional doses of propofol (0.5-1.0 mg/kg) were administered as needed to ensure patient tolerance for the remaining duration of the procedure. Movement during the procedure, hemodynamic variables, the total dose of propofol, recovery time, and adverse events were recorded. The PE group exhibited a significantly lower incidence of severe movement during the procedure compared with the PS group (14.52% vs. 32.26%, p = 0.020). The PE group showed significantly lower incidence of respiratory depression, hypotension, and severe injection pain of propofol than the PS group during the procedure (all p < 0.05). The mean arterial pressure (MAP) decreased significantly after anesthesia induction in the PS group and remained lower than baseline (all p < 0.05). Compared with the combination of low-dose sufentanil (0.2 μg/mg) with propofol, the low-dose esketamine (0.3 mg/kg) combined with propofol provided more stable hemodynamics, higher quality of sedation, and fewer adverse events in children with autism undergoing colonoscopy procedure.
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