摘要
目的探讨艾司氯胺酮对学龄前扁桃体切除患儿术后不良行为改变(NPOBCs)的影响。方法选取拟行扁桃体切除术的学龄前患儿78例,采用随机数字表法将患儿分为试验组和对照组,每组39例。麻醉诱导时,试验组静脉注射艾司氯胺酮0.5 mg/kg,对照组静脉注射生理盐水0.5 mg/kg,记录患儿入室(T_(0))、诱导后2 min(T_(1))、插管(T_(2))、手术开始(T_(3))、自主呼吸恢复(T_(4))时的心率(HR)和平均动脉压(MAP);术后30 min内进行苏醒期躁动(PAED)评分量表和改良加拿大东安大略儿童医院疼痛(m-CHEOPS)评分量表评分,术后第7、30天根据术后行为学改变(PHBQ)评分量表评估患儿NPOBCs的发生情况;记录手术时间、苏醒时间、麻醉后恢复室(PACU)停留时间和术后不良反应发生情况。结果试验组的PAED评分和m-CHEOPS评分低于对照组(P<0.05);试验组术后PAED评分与m-CHEOPS评分呈正相关(r_(s)=0.628,P<0.01);术后7 d分离焦虑与PAED评分及m-CHEOPS评分呈正相关(rs分别为0.331和0.401,均P<0.01)。与试验组相比,对照组患儿术后7 d分离焦虑及总体NPOBCs的发生率较高(P<0.05);对照组患儿术后7 d NPOBCs发生率高于术后30 d;试验组患儿苏醒时间和PACU停留时间短于对照组(P<0.05)。结论艾司氯胺酮有利于学龄前扁桃体切除患儿术后的快速康复。
Objective To investigate the effect of esketamine on negative postoperative behavioral changes(NPOBCs)in preschool children after tonsillectomy.Methods Seventy eight preschool children with tonsillectomy were selected and divided into the test group and the control group by random number table method,with 39 cases in each group.During anesthesia induction,patients in the test group were intravenously injected with 0.5 mg/kg esketamine.In contrast,those of the control group were intravenously injected with 0.5 mg/kg normal saline in the same way.Heart rate(HR)and mean arterial pressure(MAP)of children were recorded at entering the operating room(T_(0)),2 min after induction(T_(1)),intubation(T_(2)),the beginning of operation(T_(3))and the recovery of spontaneous breathing(T_(4)).The paediatric anaesthesia emergence delirium(PAED)scores and m-CHEOPS were performed 30 min after operation,and the PHBQ scores were performed 7 and 30 days after operation.The occurrence of NPOBCs was recorded in the two groups.The operation time,recovery time,PACU stay time and negative postoperative behavioral changes were recorded.Results The PAED score and m-CHEOPS score were lower in the test group than those of the control group,and the differences were statistically significant(P<0.05).PAED score was positively correlated with the m-CHEOPS score(r_(s)=0.628,P<0.01).Separation anxiety at 7 days after operation was positively correlated with PAED score and m-CHEOPS score(rs were 0.331 and 0.401,all P<0.01).The incidence of separation anxiety and overall NPOBCs was higher in children in the control group at day 7 postoperatively compared to those of the test group(P<0.05).The incidence of NPOBCs was higher at 7 days than that at 30 days postoperatively in the control group.The recovery time and PACU stay time were significantly lower in the test group than those in the control group(P<0.05).Conclusion Esketamine is beneficial to the rapid recovery of preschool children after tonsillectomy.
作者
薛建铭
孙硕
郭云飞
李晓敏
李建玲
XUE Jianming;SUN Shuo;GUO Yunfei;LI Xiaomin;LI Jianling(Department of Anesthesia,the Affiliated Hospital,Chengde Medical University,Chengde 067000,China;Department of Psychology,Chengde Medical University)
出处
《天津医药》
CAS
北大核心
2023年第9期1002-1006,共5页
Tianjin Medical Journal
