艾司氯胺酮联合丙泊酚对臂丛神经阻滞下小儿上肢手术的镇静效应

Sedative effect of esketamine combined with propofol on pediatric upper limb surgery under brachial plexus block

目的 探讨艾司氯胺酮联合丙泊酚对臂丛神经阻滞下小儿上肢手术的镇静效果。方法 选择我院2020年4月至2021年5月行上肢骨折手术患儿80例,采用随机数字表法将患儿分为丙泊酚组(P组)和艾司氯胺酮联合丙泊酚组(ESP组),每组40例。P组采用丙泊酚镇静,ESP组采用艾司氯胺酮联合丙泊酚镇静。记录麻醉前、手术开始时、术中0.5 h、手术结束时的平均动脉压(MAP)、心率(HR)和脑状态指数(CSI);记录苏醒时间、麻醉复苏室(PACU)时间、补救镇痛时间、苏醒后1 min修订面部疼痛评分(Faces Pain Scale-Revised,FPS-R)和Ramsay镇静评分;记录不良反应发生率。结果 ESP组患儿不同时点的MAP、HR明显低于P组,CSI高于P组(P<0.05);与麻醉前比较,ESP组各时点的MAP、HR和CSI明显降低(P<0.05);与P组比较,ESP组患儿苏醒时间和PACU时间明显少于P组、补救镇痛时间明显长于P组,丙泊酚用量明显少于P组(P<0.05);患儿苏醒后1 min FPS-R疼痛评分明显低于P组,Ramsay镇静评分明显高于P组(P<0.05)。ESP组患儿丙泊酚注射痛和术后躁动发生率明显低于P组(P<0.05)。结论 艾司氯胺酮联合丙泊酚镇静,可安全用于超声引导下腋路臂丛神经阻滞小儿上肢手术,提高镇静镇痛效果,不良反应少。

Objective To investigate the sedative effect of esketamine combined with propofol on pediatric upper limb surgery under brachial plexus block.Methods Eighty children who underwent upper limb fracture surgery in our hospital from April 2020 to May 2021 were selected.The children were divided into propofol group(group P) and esketamine combined with propofol group(group ESP) by random number table method,with 40 cases in each group.Group P was sedated with propofol,and group ESP was sedated with esketamine combined with propofol.The mean arterial pressure(MAP),heart rate(HR) and cerebral state index(CSI) were recorded before anesthesia,at the beginning of operation,0.5 h during operation and at the end of operation.Anesthesia recovery time,post-anesthesia care unit(PACU) stay time,postoperative recovery analgesia time,and the Faces Pain Scale-Revised(FPS-R) score and Ramsay sedation score 1 min after recovery were recorded.The incidence of adverse reactions was recorded.Results MAP and HR in group ESP were significantly lower than those in group P at different time points,while CSI was higher than that in group P(P<0.05).Compared with before anesthesia,MAP,HR and CSI were significantly decreased in group ESP(P<0.05).Compared with group P,the anesthesia recovery time and PACU stay time in group ESP were significantly shorter,the postoperative analgesia time was significantly longer,and the dosage of propofol in group ESP was significantly lower(P<0.05).The FPS-R pain score in group ESP was significantly lower than that in group P,and the Ramsay sedation score was significantly higher(P<0.05).The incidence of propofol injection pain and postoperative agitation in group ESP was significantly lower than that in group P(P<0.05).Conclusion Esketamine combined with propofol sedation can be safely used for ultrasound-guided axillary brachial plexus block in pediatric upper limb surgery,which can improve the sedative and analgesic effect with fewer adverse reactions.