术前静脉注射艾司氯胺酮对学龄前儿童镇静及诱导合作的临床观察

Clinical observation of preoperative intravenous administration of esketamine on sedation and induction compliance in preschool children

目的探讨术前静脉注射不同剂量艾司氯胺酮对学龄前儿童镇静效果和麻醉诱导合作度的影响。方法全麻下行腹腔镜疝囊高位结扎术的患儿90例,年龄1~6岁。采用随机数字表法将患儿分为S_(1)组、S_(2)组和S_(3)组(静脉注射艾司氯胺酮的剂量分别为0.6、0.8和1.0 mg/kg),每组30例。记录患儿用药前(T0)、用药后1 min亲子分离时(T_(1))和麻醉诱导时(T_(2))的Ramsay镇静评分、心率及麻醉诱导合作量表(ICC)评分,镇静时与苏醒后的不良反应以及苏醒时间。结果T_(1)和T_(2)时,S_(2)组和S_(3)组Ramsay镇静评分优于S_(1)组(P<0.05),且T_(2)时S_(3)组Ramsay镇静评分高于S_(2)组(P<0.05)。S_(3)组ICC评分低于S_(1)组与S_(2)组(P<0.05),S_(1)组与S_(2)组差异无统计学意义(P>0.05)。3组患儿ICC级别差异有统计学意义(P<0.05)。S_(3)组诱导合作完美(ICC=0分)的患儿比例显著高于S_(1)组和S_(2)组,诱导合作差(ICC=4~10分)的患儿比例显著低于S_(1)组和S_(2)组(P<0.05)。各组不良反应发生率与苏醒时间差异无统计学意义(P>0.05)。结论术前静脉注射艾司氯胺酮0.8 mg/kg和1.0 mg/kg均可提升学龄前儿童的术前镇静效果,但1.0 mg/kg的剂量麻醉诱导时镇静效果和诱导合作度更优。

Objective To explore the effect of preoperative intravenous administration of different doses of esketamine on sedation and anesthesia induction compliance in preschool children.Methods A total of 90 children scheduled for laparoscopic high ligation of hernia under general anesthesia were allocated,aged 1 to 6 years.The children were divided into the S_(1) group,the S_(2) group and the S_(3) group(according to different intravenous doses of esketamine 0.6 mg/kg,0.8 mg/kg and 1.0 mg/kg respectively)by random number table method,with 30 patients in each group.The Ramsay sedation score of children were recorded before medication(T_(0)),separating with parents 1 min after medication(T_(1))and anesthesia induction(T_(2)).Induction Compliance Checklist(ICC)score and heart rate were also recorded.The adverse events during sedation and after recovery,and the recovery time were recorded.Results At T_(1) and T_(2),the Ramsay sedation score was better in the S_(2) group and the S_(3) group than that of the S_(1) group(P<0.05),and the Ramsay score of the S_(3) group was higher than that of the S_(2) group at T_(2)(P<0.05).The ICC score was lower in the S_(3) group than that of the S_(1) group and the S_(2) group(P<0.05).There was no significant difference in ICC score between the S_(1) group and the S_(2) group(P>0.05).There were significant differences in ICC grades between the three groups(P<0.01).The proportion of children with perfect induction cooperation(ICC=0)was significantly higher in the S_(3) group than that in the S_(1) group and the S_(2) group,and the proportion of children with poor induction cooperation(ICC=4-10)was significantly lower in the S_(3) group than that in the S_(1) group and the S_(2) group(P<0.05).There were no significant differences in the incidence of adverse events and recovery time between the three groups(P>0.05).Conclusion Preoperative intravenous administration of esketamine 0.8 mg/kg and 1.0 mg/kg can improve the sedation effect of preschool children,but the sedation effect and induction compliance is superior with 1.0 mg/kg anesthesia induction.