艾司氯胺酮复合右美托咪定在儿童扁桃体切除术中的应用效果

The effect of esketamine combined with dexmedetomidine on children undergoing tonsillectomy

目的:观察艾司氯胺酮复合右美托咪定预处理对儿童扁桃体切除术后血流动力学及苏醒躁动的影响。方法:选择2020年2月至12月台州市中心医院择期行扁桃体切除术患儿80例,年龄5~13岁,ASA分级I或II级。采用随机数字表法分成对照组(E组)和观察组(ED组),每组40例。E组和ED组分别在麻醉诱导前10 min静脉泵注艾司氯胺酮0.5 mg/kg和艾司氯胺酮0.5 mg/kg+右美托咪定1.0μg/kg,均用0.9%氯化钠溶液稀释至10 mL。采用小儿麻醉苏醒躁动评分量表(PAED)和疼痛行为评分量表(FLACC)对患儿进入麻醉后恢复室(PACU)后30 min内的躁动发生及疼痛情况进行评分,并记录患儿麻醉前(T_(0))、拔管时(T_(1))、拔管后5 min(T_(2))、10 min(T_(3))的心率(HR)和平均动脉压(MAP)以及手术时间、苏醒时间、PACU停留时间和术后不良反应发生情况。结果:两组患儿术后FLACC评分比较,差异无统计学意义(P>0.05),ED组患儿术后PAED评分显著低于E组(P<0.05)。两组患儿T_(0)和T_(3)时的MAP和HR比较,差异无统计学意义(P>0.05),但ED组在T_(1)和T_(2)时MAP和HR明显低于E组(P<0.05)。两组患儿手术时间、苏醒时间和PACU停留时间比较,差异无统计学意义(P>0.05)。此外,ED组患儿术后头晕、恶心呕吐等不良反应发生率低于E组,差异有统计学意义(χ^(2)=4.501,P=0.034)。结论:艾司氯胺酮复合右美托咪定用于患儿扁桃体切除术能够有效降低麻醉苏醒期躁动发生,血流动力学更加稳定且术后不良反应更少,临床效果显著。

Objective:To investigate the effect of pretreatment with esketamine+dexmedetomidine(DEX)on hemodynamics and emergence agitation(EA)in children undergoing tonsillectomy.Methods:Eighty children from February to December 2020(ASA classⅠ-Ⅱ,aged 5 to 13 years)underwent tonsillectomy in Taizhou Central Hospital were randomly divided as group E and group ED,with 40 cases each.Before anesthesia induction,children in group E received esketamine 0.5 mg/kg,while those in group ED received equal volume(10 mL)of esketamine 0.5 mg/kg+DEX 1.0μg/kg.Pediatric anesthesia emergence delirium(PAED)and face,legs,activity,cry,consolability(FLACC)scales were used to score the EA and pain within 30 min after entering the post-anesthetic care unit(PACU).Heart rate(HR)and mean arterial pressure(MAP)were recorded before anesthesia(T_(0)),when extubation(T_(1)),5 min(T_(2))and 10 min(T_(3))after extubation.Operation time,emergence time,PACU residence time,and adverse reactions were also recorded.Results:There was no statistically difference in FLACC scores between the two groups(P>0.05).The PAED score of group ED was significantly lower than that of group E(P<0.05).There were no significant differences in MAP and HR between the two groups at T_(0),T_(3),however,HR and MAP in group ED at T_(1)and T_(2)were lower than in group E(P<0.05).There were no significant differences in the operation time,emergence time and PACU residence time between the two groups(P>0.05).The incidence of adverse reactions such as dizziness,nausea and vomiting in group ED was obviously lower than in group E(P<0.05).Conclusion:The application of esketamine combined with DEX in children undergoing tonsillectomy can effectively reduce the incidence of emergence agitation,improve hemodynamic stability and decrease adverse reactions,which is of remarkable clinical significance.