摘要
目的研究不同艾司氯胺酮给药方案在学龄前儿童泌尿外科日间手术中的麻醉管理及术后疼痛的影响。方法选取广东省妇幼保健院2022-06/2023-01期间计划在气管插管全身麻醉下进行择期泌尿外科日间手术的患儿60例,年龄2~6岁,ASA分级Ⅰ或Ⅱ级,采用随机数字表法将患儿分为对照组(C组,n=20);艾司氯胺酮0.3 mg/kg组(MK组,n=20);艾司氯胺酮0.5 mg/kg组(HK组,n=20)。术中吸入1.3 MAC七氟醚维持麻醉,记录入室后(T_(0))、麻醉诱导后3 min(T_(1))、手术切皮时(T_(2))、手术开始后10 min(T_(3))、拔出喉罩时(T_(4))的心率(HR)、平均动脉压(MAP)。记录麻醉时间、手术时间及麻醉拔管时间、麻醉恢复室(PACU)停留时间。记录拔出喉罩后5 min(T_(5))、1 h(T_(6))、24 h(T 7)的疼痛评分和镇静评分情况,记录术后不良反应发生情况,记录术中及PACU舒芬太尼的追加剂量和追加次数。结果在T_(1)时间点,MK组和HK组的MAP较C组有统计学意义(P<0.05),在T_(5)和T_(6)时间点,MK组和HK组镇痛评分低于C组(P<0.05);HK组镇静评分高于C组和MK组(P<0.05);MK组和HK组舒芬太尼在术中及PACU追加剂量低于C组(P<0.05);与C组、MK组比较,HK组会明显延长拔管时间和在PACU的停留时间(P<0.05);HK组术后头晕的发生率高于C组和MK组(P<0.05);在舒芬太尼的追加次数上,C组明显高于MK和HK组(P<0.05)。结论艾司氯胺酮0.3 mg/kg静脉诱导可以降低学龄前患儿泌尿外科日间手术舒芬太尼的使用量,并能维持较稳定的血流动力学水平,减轻术中和术后的疼痛,获得更加满意的镇静效果,且不会增加拔管时间、复苏时长及术后不良反应等。
Objective To investigate the effects of different esketamine administration regimens on anesthetic management and postoperative pain in preschool children undergoing ambulatory urologic surgery.Methods Sixty children aged 2 to 6 years old,ASA class Ⅰ or Ⅱ,scheduled for elective ambulatory urologic surgery under general anesthesia with tracheal intubation from June 2022 to January 2023 in our hospital,were selected and divided into control group(group C,n=20);esketamine 0.3 mg/kg group(group MK,n=20);and esketamine 0.5 mg/kg group(group HK,n=20)according to random number table method.Intraoperative anesthesia was maintained by inhalation of 1.3 MAC sevoflurane,and HR and MAP were recorded after admission to the room(T_(0)),3 min after induction of anesthesia(T_(1)),at the time of surgical skin incision(T_(2)),10 min after the start of surgery(T_(3)),and at the time of removal of the laryngeal mask(T_(4)).The anesthesia time,operation duration,anesthesia withdrawal time,and resuscitation room stay time were recorded.The pain scores and sedation scores at 5 min(T_(5)),1 h(T_(6))and 24 h(T 7)after removal of the laryngeal mask were recorded,the occurrence of postoperative adverse reactions was recorded,and the additional number and doses of sufentanil intraoperatively as well as in the PACU were recorded.Results At T_(1),MAP in group MK and group HK were statistically significant compared with those in group C(P<0.05);at T_(5) and T_(6),the analgesic scores in group MK and HK were lower than those in group C(P<0.05);the sedation scores in group HK were higher than those in group C and group MK(P<0.05);the additional doses of sufentanil in group MK and HK were less than those in group C intraoperatively and in the PACU(P<0.05);compared with group C and group MK,the extraction time and the length of stay in the PACU were significantly longer than that in group HK(P<0.05);the incidence of postoperative dizziness in group HK was higher than that in group C and group MK(P<0.05);as for the number of additional doses of
作者
杨亮
邓恋
漆冬梅
陈祥楠
黎昆伟
孙艺娟
YANG Liang;DENG Lian;QI Dongmei;CHEN Xiangnan;LI Kunwei;SUN Yijuan(Department of Anesthesiology,Guangdong Women and Children Hospital,Guangzhou 511400,China)
出处
《麻醉安全与质控》
2024年第2期61-65,共5页
Perioperative Safety and Quality Assurance
基金
广东省医学科研基金(B2021238)
广州市科技计划项目(201904010460)。
