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| 小剂量艾司氯胺酮对患儿扁桃体腺样体切除术全麻苏醒期躁动的影响 |
| Effect of small dose of esmketamine on emergence agitation in children undergoing tonsillectomy |
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| DOI：10.12089/jca.2022.02.009 |
| 中文关键词: 艾司氯胺酮 扁桃体腺样体切除术 苏醒期躁动 患儿 |
| 英文关键词: Tonsillectomy Emergence agitation Esmketamine Children |
| 基金项目:国家卫生健康委科学研究基金（SBGJ202002066）；国家自然科学基金青年科学基金项目（82001187） |
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| 中文摘要: |
目的 探讨全麻诱导前预防性应用小剂量艾司氯胺酮对患儿扁桃体腺样体切除术全麻苏醒期躁动（EA）的影响。
方法 选择2021年1—3月择期行扁桃体腺样体切除术的患儿97例，男48例，女49例，年龄3～12岁，体重15～50 kg，ASAⅠ或Ⅱ级。采用随机数字表法将患儿分为两组：艾司氯胺酮组（S组，n=49）和对照组（C组，n=48）。入室后即刻S组静脉注射艾司氯胺酮0.3 mg/kg， C组静脉滴注等体积生理盐水。所有患儿全麻诱导和术中麻醉维持相同，术毕即刻停药并将患儿转运至PACU行全麻复苏。采用Aono四分评级法进行患儿苏醒期评分，评估患儿麻醉恢复阶段的躁动水平。记录麻醉诱导时哭闹情况、SpO2、PETCO2。记录拔管后15 min的Aono评分和FLACC疼痛评分、苏醒期丙泊酚追加例数、苏醒时间、拔管时间、PACU停留时间。记录EA、术后呛咳、苏醒延迟、恶心呕吐、切口出血、低血压、心动过缓、分泌物增多和SpO2<95%等不良反应发生情况。
结果 与C组比较，S组麻醉诱导时哭闹发生率、拔管后15 min Aono评分和FLACC疼痛评分明显降低（P<0.05），苏醒期丙泊酚追加例数明显减少（P<0.05），EA、术后呛咳发生率明显降低（P<0.05）。两组术后恶心呕吐和SpO2<95%发生率差异无统计学意义。两组均未出现呼吸抑制、切口出血、低血压、心动过缓、苏醒延迟或分泌物增多。
结论 麻醉前预防性应用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EA的发生率，不延长术后恢复时间，安全性高，不良反应少。 |
| 英文摘要: |
Objective To investigate the effect of prophylactic application of small dose of esmketamine before induction of general anesthesia on emergence agitation during recovery period of general anesthesia in children undergoing tonsillectomy.
Methods Ninty-seven children undergoing tonsillectomy, 48 males and 49 females, aged 3-12 years, weighing 15-50 kg, ASA physical status Ⅰ or Ⅱ, from January 2021 to March 2021 were selected. The children were randomly divided into two groups using random number table method: esmketamine group (group S, n = 49) and control group (group C, n = 48). Group S received intravenous injection of esmketamine 0.3 mg/kg and then was carried into the room, group C was injected with equal volume of normal saline intravenously. After the above treatment, the two groups of children underwent the same general anesthesia induction and intraoperative anesthesia maintenance. The drugs were stopped immediately after operation, and the children were transferred to PACU for general anesthesia resuscitation. Aono four point rating method was used to score the recovery period of children, and to evaluate the restlessness level of children in the recovery stage of anesthesia. The incidence of crying during induction, SpO2, PETCO2 were recorded. Aono score and FLACC pain score 15 minutes after extubation, the number of additional cases of propofol in recovery period, recovery time, extubation time and PACU residence time were recorded. The occurrence of adverse events such as emergence agitation, choking cough after surgery, delayed awakening, nausea and vomiting, incision bleeding, hypotension, bradycardia, increased secretion and SpO2 < 95% were recorded.
Results Compared with group C, the incidence of crying during induction, Aono score and FLACC pain score 15 minutes after extubation were decreased significantly in group S (P < 0.05), the number of additional cases of propofol in recovery period was decreased significantly in group S (P < 0.05), the incidence of EA and choking cough after surgery were decreased significantly in group S (P < 0.05). There were no significantly differences in nausea and vomiting and SpO2 < 95% between the two groups. There were no respiratory depression, incision bleeding, hypotension, bradycardia, delayed awakening or increased secretion occurred in the two groups.
Conclusion Prophylactic application of low-dose esmketamine before anesthesia can effectively reduce the incidence of EA after tonsillectomy, without prolonging the postoperative recovery time, with high safety and less adverse reactions． |
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