摘要
目的观察不同剂量艾司氯胺酮联合丙泊酚对小儿腺样体扁桃体切除术后苏醒质量和谵妄的影响。方法前瞻性选取2022年1月至2024年10月安徽省蚌埠市第三人民医院收治的106例择期进行腺样体扁桃体切除术的患儿为研究对象,采用随机数字表法将研究对象分为低剂量组(给予盐酸艾司氯胺酮注射液0.25 mg/kg,35例)、中剂量组(给予盐酸艾司氯胺酮注射液0.5 mg/kg,35例)、高剂量组(给予盐酸艾司氯胺酮注射液0.75 mg/kg,36例)。比较分析三组患儿麻醉诱导前(T0)、插管即刻(T1)、手术开始时(T2)及拔管时(T3)的血流动力学水平[平均动脉压(MAP)和心率(HR)]。比较分析三组患儿的手术相关指标、术后疼痛程度[行为学疼痛评估量表(FLACC)评分]、躁动情况[儿童麻醉苏醒期躁动量表(PAED)评分]、苏醒期追加丙泊酚情况、术后谵妄及不良反应发生情况。结果T1、T2时刻,低剂量组、中剂量组患儿的MAP、HR均低于高剂量组;T3时刻,低剂量组、中剂量组患儿的HR均低于高剂量组,差异均有统计学意义(P<0.05)。低剂量组、中剂量组患儿的苏醒时间、气管导管拔除时间及麻醉恢复室停留时间均短于高剂量组,差异有统计学意义(P<0.05)。中剂量组患儿的FLACC评分、PAED评分均低于低剂量组和高剂量组,中剂量组患儿苏醒期追加丙泊酚比例低于低剂量组,差异均有统计学意义(P<0.05)。中剂量组患儿的术后谵妄发生率低于高剂量组,差异有统计学意义(P<0.05)。三组患儿的术后不良反应发生率比较差异均无统计学意义(P>0.05)。结论艾司氯胺酮0.5 mg/kg联合丙泊酚可更有效维持小儿腺样体扁桃体切除术的术中血流动力学水平稳定,提升患儿术后苏醒质量,减少谵妄的发生,且安全性良好。
Objective To observe the effects of different doses of esketamine combined with propofol on the recovery quality and delirium after adenotonsillectomy in children.Method A total of 106 children scheduled for adenotonsillectomy in the Third People’s Hospital of Bengbu City from January 2022 to October 2024 were prospectively selected as the research subjects.They were divided into the low-dose group(given 0.25 mg/kg esketamine,35 cases),medium-dose group(given 0.5 mg/kg esketamine,35 cases),and high-dose group(given 0.75 mg/kg esketamine,36 cases)by the random number table method.The hemodynamic levels(MAP,HR)in the three groups before anesthesia induction(T0),immediately after intubation(T1),at the beginning of the surgery(T2),and at extubation(T3)were compared and analyzed.The surgery-related indicators,postoperative pain degree(FLACC score),restlessness(PAED score),the addition of propofol during the awakening period,the occurrence of postoperative delirium and the occurrence of adverse reactions in the three groups were compared and analyzed.Result At T1 and T2,the MAP and HR in the low-dose group and the medium-dose group were lower than those in the high-dose group,with statistical signifi cance(P<0.05).At T3,the HR in the low-dose group and the medium-dose group was lower than that in the high-dose group,with statistical signifi cance(P<0.05).The recovery time,tracheal tube removal time and PACU stay time in the low-dose group and the medium-dose group were all shorter than those in the high-dose group,with statistical signifi cance(P<0.05).The FLACC score and PAED score in the medium-dose group were lower than those in the low-dose group and the highdose group,and the proportion who received additional propofol during the recovery period in the medium-dose group was lower than that in the low-dose group,with statistical significance(P<0.05).The incidence of postoperative delirium in the medium-dose group was lower than that in the high-dose group,with statistical signifi cance(P<0.05).There was no statistically signifi cant difference in the incidence of postoperative adverse reactions among the three groups(P>0.05).Conclusion 0.5 mg/kg esketamine combined with propofol can more effectively maintain the hemodynamic level stability of adenotonsillectomy in children,and improve the postoperative recovery quality,and reduce the occurrence of delirium,with good safety.
作者
鲍奎斌
刘倩影
汤芸芸
郭斌
邓维
Bao Kuibin;Liu Qianying;Tang Yunyun;Guo Bin;Deng Wei(Department of Anesthesiology,Third People’s Hospital of Bengbu City,Bengbu Anhui 233000,China;Department ofAnesthesiology,Wuhu Second People’s Hospital,Wuhu Anhui 241100,China)
出处
《中国医刊》
2025年第8期925-929,共5页
Chinese Journal of Medicine
基金
安徽省自然科学基金(2008087MA318)。
作者简介
通信作者:刘倩影,E-mail:13085520309@163.com。
