右美托咪定与丙泊酚联合氯胺酮在成人诊疗镇静中的有效性：一项随机临床试验。
Dexmedetomidine versus propofol: An effective combination with ketamine for adult procedural sedation: A randomized clinical trial.
机构信息
Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
出版信息
Am J Emerg Med. 2023 Nov;73:95-101. doi: 10.1016/j.ajem.2023.08.025. Epub 2023 Aug 15.
BACKGROUND
Recently, drug combination protocols have been preferred over single drugs in procedural sedation and analgesia (PSA). This study aimed to compare the effectiveness and hemodynamic profile of ketamine-dexmedetomidine (ketodex) and ketofol as drug combinations with ketamine as a single medication for PSA in the emergency department (ED).
METHODS
This prospective, randomized, double-blind clinical trial was performed among adult patients (≥18 years) requiring PSA for a painful procedure in the ED. 135 patients were enrolled and assigned into three equal groups to receive either ketodex, ketofol, or ketamine. Additional ketamine was used as a rescue agent for inadequate sedation in three groups. Oxygen saturation, heart rate, and blood pressure were recorded from baseline until 120 min after induction of PSA. Adverse events, hemodynamic variables, induction, and recovery time were recorded and compared between groups.
RESULTS
The mean age of the patients was 38.16 ± 19.09 years and no differences were observed between the three groups in terms of demographic variables, pain scores, and procedures between the three groups. Respiratory events had similar incidences between the three groups. The O2 reduction was less in the Ketodex group in comparison with Ketofol and Ketamine groups (1.9%, 6.5%, and 3.8%, P = 0.015). No patient needed endotracheal intubation. Changes in mean arterial pressure from the baseline in Ketamine and Ketofol groups compared to Ketodex was higher (difference was 12.9 mmHg [95% CI, 9.5 to 20.3] and 8.6 mmHg [95% CI, 3.4 to 13.7]. Tachycardia in the Ketamine group had a significantly higher incidence. The recovery time was statistically shorter in the Ketofol group in comparison with other groups. The differences between Ketofol with Ketamine and Ketodex groups were 9.8 min (95% CI, [2.5 to 17.1]) and 8.3 min (95% CI, [1.5 to 15.1]).
CONCLUSION
Ketodex, as well as ketofol, were effective and safe combinations with good recovery profiles and hemodynamic stability for adult PSA in ED.
背景
最近，在程序镇静和镇痛（PSA）中，药物联合方案已优于单一药物。本研究旨在比较氯胺酮-右美托咪定（氯胺酮）和酮氟醚作为联合药物与单独使用氯胺酮在急诊科（ED）进行 PSA 的有效性和血液动力学特征。
方法
这是一项前瞻性、随机、双盲临床试验，纳入了需要在 ED 进行疼痛程序的 PSA 的成年患者（≥18 岁）。共纳入 135 例患者，并分为三组，分别接受氯胺酮、酮氟醚或氯胺酮。三组均将额外的氯胺酮作为镇静不足的抢救药物。从 PSA 诱导前至 120 分钟，记录血氧饱和度、心率和血压。记录不良事件、血液动力学变量、诱导和恢复时间，并比较组间差异。
结果
患者的平均年龄为 38.16±19.09 岁，三组在人口统计学变量、疼痛评分和程序方面无差异。三组的呼吸事件发生率相似。与酮氟醚和氯胺酮组相比，氯胺酮组的 O2 减少量较少（分别为 1.9%、6.5%和 3.8%，P=0.015）。没有患者需要气管插管。与氯胺酮组相比，氯胺酮和酮氟醚组的平均动脉压从基线的变化更高（差异分别为 12.9mmHg[95%CI，9.5 至 20.3]和 8.6mmHg[95%CI，3.4 至 13.7]）。氯胺酮组心动过速的发生率明显更高。与其他组相比，酮氟醚组的恢复时间更短。酮氟醚与氯胺酮和氯胺酮组的差异分别为 9.8 分钟（95%CI，[2.5 至 17.1]）和 8.3 分钟（95%CI，[1.5 至 15.1]）。
结论
氯胺酮和酮氟醚都是有效的组合，具有良好的恢复情况和血液动力学稳定性，适用于 ED 中的成人 PSA。
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