右美托咪啶滴鼻复合艾司氯胺酮麻醉加速舌系带成形术患儿围手术期康复

Perioperative rehabilitation of children undergoing lingual frenoplasty under dexmedetomidine nasal drip combined with esketamine anesthesia

目的观察右美托咪啶滴鼻复合艾司氯胺酮麻醉是否有助舌系带成形术患儿快速康复。方法选取2020年—2021年在长沙市妇幼保健院100例行舌系带成形术患儿,采用随机数字表法分为艾司氯胺酮组(E组,50例)和右美托咪啶滴鼻复合艾司氯胺酮组(DE组,50例),观察患儿滴鼻前(T_(0))、入室后(T_(1))、手术开始(T_(2))及术后10 min(T_(3))、30 min(T_(4))、60 min(T_(5))、120 min(T6)平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO_(2))及呼吸频率(RR),术后入麻醉恢复室(PACU),观察术后10、30、60、120 min改良Aldrete评分、疼痛视觉模拟评分、苏醒躁动评分及观察进食(清水)时间、离院时间。结果两组患儿SpO_(2)、RR、T_(0)和T6时血压及HR差异无统计学意义(均P>0.05);DE组T_(1)、T_(2)、T_(3)、T_(4)、T_(5)时MAP及HR低于E组(均P<0.05);DE组改良Aldrete评分高于E组,苏醒躁动评分、疼痛视觉模拟评分低于E组,进食(清水)时间及离院时间短于E组,差异均有统计学意义(均P<0.05)。结论在小儿舌系带成形术中,右美托咪啶滴鼻复合艾司氯胺酮较单独使用艾司氯胺酮能更有效缓解术后疼痛及躁动,缩短患儿术后进食时间,尽早离院,实现患儿加速康复。

Objective To observe the perioperative rehabilitation of children undergoing lingual frenoplasty under dexmedetomidine nasal drip combined with esketamine anesthesia.Methods 100 children who underwent lingual frenoplasty in Changsha Maternal and Child Health Hospital from 2020 to 2021 were randomly divided into two groups:the esketamine group(E group,50 cases)and the dexmedetomidine nasal drip combined with esketamine group(DE group,50 cases).The mean arterial pressure(MAP),heart rate(HR),blood oxygen saturation(SpO_(2))and respiratory rate(RR)were measured,and the patients were admitted to the post anesthesia recovery unit(PACU)after operation.The modified Aldrete score,Visual Analogue Score(VAS),Wake-up Restlessness Score,food intake(clear water)time and hospital leaving time were observed at 10 min,30 min,60 min and 120 min after operation.Results There was no significant difference in SpO_(2) and RR,MAP and HR at T_(0) and T6 between the two groups(all P>0.05).The MAP and HR at T_(1),T_(2),T_(3),T_(4) and T_(5) in DE group were lower than those in E group(all P<0.05).The modified Aldrete score of DE group was higher than that of E group,and the VAS and Wake-up Restlessness Score were lower than that of E group(all P<0.05);The time of food intake(clear water)and leaving hospital were shorter than those in Group E,with statistically significant difference(all P<0.05).Conclusions In children's lingual frenoplasty,dexmedetomidine nasal drip combined with esmketamine can more effectively relieve postoperative pain and agitation than esmketamine alone,shorten children's postoperative eating time,leave the hospital earlier,and enhance recovery of children.