摘要
目的探讨手术结束时静脉注射小剂量艾司氯胺酮对行扁桃体腺样体切除术患儿全麻苏醒期谵妄(ED)的影响。方法选择2024年1月-2025年4月在苏州市立医院择期行扁桃体腺样体切除术患儿77例,男43例,女34例,年龄3-7岁,ASAⅠ-Ⅱ级。采用随机数表法将患儿分成两组:艾司氯胺酮组(SK组,n=38)和生理盐水对照组(NS组,n=39)。两组患儿均接受静吸复合麻醉,手术结束即刻,SK组静脉注射艾司氯胺酮0.2mg/kg,NS组静脉注射等容量生理盐水。待患儿苏醒拔管后转运至PACU行全麻复苏。分别采用PAED量表、Aono躁动评分法及CHEOPS量表评估患儿ED发生情况及疼痛程度。记录患儿PACU停留时间、手术时间、麻醉时间、拔管时间及丙泊酚补救镇静率。记录术后24h内不良事件发生率。结果两组患儿基线资料、PACU停留时间、手术时间、麻醉时间、拔管时间差异无统计学意义(P>0.05)。与NS组相比,SK组患儿术后PAED评分、Aono躁动评分及CHEOPS评分均降低,差异有统计学意义(P<0.05);SK组患儿接受丙泊酚补救镇静率明显低于NS组,差异有统计学意义(P<0.05);两组患儿术后PONV发生率差异无统计学意义,且均未发生气道及精神系统并发症。结论手术结束时,静脉注射小剂量艾司氯胺酮可有效降低患儿扁桃体腺样体切除术后ED发生率及严重程度,并减轻疼痛,且不延长苏醒时间和PACU停留时间,不良反应少,安全性高。
Objective To investigate the efficacy of S-ketamine administered at the end of surgery for prevention of emergence delirium(ED)after tonsillectomy and/or adenoidectomy in children.Methods Seventy-seven children,43 males and 34 females aged 3-7 years,of American Society of Anesthesiologists physical statusⅠ-Ⅱ,scheduled for elective tonsillectomy and/or adenoidectomy at Suzhou Municipal Hospital from January 2024 to April 2025 were divided into two groups by using a random number table method:S-ketamine group(SK group,n=38)and normal saline group(NS group,n=39).Children received sevoflurane and propofol anesthesia,and were administered either S-ketamine 0.2mg/kg or equal volume of normal saline at the end of surgery.After extubation,all children were transferred to PACU for recovery.Pediatric anesthesia emergence delirium scale(PAED),Aono’s scale and Children’s Hospital of Eastern Ontario Pain Scale(CHEOPS)were evaluated in the first 30min in PACU.The highest score of each scale were recorded.Additionally,the length of staying in PACU,the duration of surgery and anesthesia,the extubation time,the incidence of rescue sedation with propofol,and the occurrence of adverse events such as PONV,respiratory depression and mental disorder were recorded.Results There were no significant differences in baseline data between the two groups(P>0.05).The length of staying in PACU,the duration of surgery and anesthesia,the extubation time were comparable between the two groups(P>0.05).Children in the SK group exhibited less PAED,Aono’s scale and CHEOPS scores than those in NS group(P<0.05).The incidence of rescue sedation with propofol was significantly decreased in the SK group compared to the NS group(P<0.05).The incidence of PONV and other adverse events were comparable between the two groups(P>0.05).Conclusion S-ketamine administered at the end of surgery can effectively reduce the incidence of ED and the severity degree after tonsillectomy and/or adenoidectomy in children,with better analgesia and less adverse events.
作者
王敏
袁梅
Wang Min;Yuan Mei(Suzhou Municipal Hospital,the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou,Jiangsu 215008,China)
出处
《首都食品与医药》
2025年第19期75-77,共3页
Capital Food Medicine
作者简介
通信作者:袁梅,邮箱:crpl8900@163.com。
