对艾司氯胺酮在烧伤后瘢痕手术患儿静脉穿刺中的应用效果观察

Effect of esmketamine on venipuncture in children undergoing burn scar surgery

目的探讨艾司氯胺酮在烧伤后瘢痕手术患儿静脉穿刺中的应用效果。方法选择2020年1月至2021年8月于空军军医大学第一附属医院烧伤与皮肤外科进行烧伤后瘢痕手术患儿168例,采用随机数字表法,分为常规组(52例)、七氟烷组(56例)、艾司氯胺酮组(60例)。常规组患儿采用常规静脉穿刺,七氟烷组患儿静脉穿刺前吸入七氟烷,艾司氯胺酮组患儿在手术室外肌肉注射艾司氯胺酮后入室进行静脉穿刺。比较3组患儿入室时与穿刺时心率、呼吸、血氧饱和度,1次性穿刺成功率、穿刺次数、置管型号(22G或24G)、成功置管耗时、入室至穿刺成功时间以及并发症发生率。结果入室时常规组和七氟烷组心率[(130.98±5.73)次/min、(131.27±5.42)次/min]、呼吸[(31.88±3.63)次/min、(32.11±3.50)次/min]高于艾司氯胺酮组[(102.86±9.32)次/min、(21.75±3.48)次/min],血氧饱和度(91.62%±2.64%、92.45%±2.61%)低于艾司氯胺酮组(98.83%±2.09%);穿刺时七氟烷组、艾司氯胺酮组心率[(104.12±11.26)次/min、(100.28±6.80)次/min]、呼吸[(21.98±4.43)次/min、(20.62±1.75)次/min]低于常规组[(140.83±5.94)次/min、(37.40±3.13)次/min],血氧饱和度(98.41%±3.22%、99.32%±0.98%)高于常规组(88.04%±1.58%),差异均有统计学意义(P<0.05)。艾司氯胺酮组1次穿刺成功率(63.3%)高于常规组(32.7%)和七氟烷组(51.8%);常规组穿刺次数(2.94±1.81)多于七氟烷组(2.04±1.25)和艾司氯胺酮组(1.65±0.80),差异均有统计学意义(P<0.05)。置管型号22G在常规组中比例(15.4%)低于七氟烷组(32.1%)和艾司氯胺酮组(43.3%),差异有统计学意义(P<0.05)。常规组入室至穿刺成功时间[(9.41±2.17)min]长于七氟烷组[(6.58±1.60)min]和艾司氯胺酮组[(4.18±1.63)min],3组间差异有统计学意义(P<0.05)。常规组穿刺部位并发症发生率均高于七氟烷组和艾司氯胺酮组,差异有统计学意义(P<0.05)。结论患儿手术麻醉前给予艾司氯胺酮肌肉注射后行静脉穿刺,可使患儿入室时生命体征平稳,提高1次性穿刺成功率,缩短入室至穿刺成功时间,减少非手术时间,具有良好的临床应用效果。

Objective To investigate the application effect of esmketamine in venipuncture of children undergoing burn surgery.Methods A total of 168 children who underwent burn scar surgery in the First Affiliated Hospital of Air Force Military Medical University from January 2020 to August 2021 were randomly divided into 52 cases in the routine group,56 cases in the sevoflurane group and 60 cases in the esmketamine group.The children in the routine group underwent routine venipuncture,the children in the sevoflurane group inhaled sevoflurane before venipuncture,and the children in the esmketamine group entered the room for venipuncture after intramuscular injection of esmketamine outside the operating room.The heart rate,respiration,blood oxygen saturation,the success rate of one-time puncture,the number of puncture,catheter type(22G or 24G),the time of successful catheterization,the time from entering to successful puncture and the occurrence of complications were compared among the three groups.Results At admission,the heart rate[(130.98±5.73)times/min,(131.27±5.42)times/min],respiration[(31.88±3.63)times/min,(32.11±3.50)times/min]in the routine group and sevoflurane group were higher than those in the esketamine group[(102.86±9.32)times/min,(21.75±3.48)times/min],and the blood oxygen saturation(91.62%±2.64%,92.45%±2.61%)were lower than that in the esketamine group(98.83%±2.09%).At the time of puncture,the heart rate[(104.12±11.26)times/min,(100.28±6.80)times/min],respiration[(21.98±4.43)times/min,(20.62±1.75)times/min]in the sevoflurane group and the esketamine group were lower than those in the routine group[(140.83±5.94)times/min,(37.40±3.13)times/min],and the blood oxygen saturation(98.41%±3.22%,99.32%±0.98%)were higher than that in the routine group(88.04%±1.58%),with statistically significant differences(P<0.05).The success rate of one-time puncture was higher in the esketamine group(63.3%)than that in the routine group(32.7%)and the sevoflurane group(51.8%),and the number of puncture in the routine group(2.94±1.81)was more than that in the sevoflurane group(2.04±1.25)and the esketamine group(1.65±0.80),with statistically significant differences(P<0.05).The proportion of catheter type 22G in the routine group(15.4%)was lower than that of the sevoflurane group(32.1%)and the esketamine group(43.3%),with statistically significant difference(P<0.05).The time from entering the room to successful puncture in the routine group[(9.41±2.17)min]was longer than that in the sevoflurane group[(6.58±1.60)min]and the esketamine group[(4.18±1.63)min],and the difference between the three groups was statistically significant(P<0.05).The incidence of complications at the puncture site in the routine group were higher than those in the sevoflurane group and the esketamine group,with statistically significant difference(P<0.05).Conclusion Venipuncture after intramuscular injection of esmketamine before surgical anesthesia can stabilize the vital signs of children when entering the room,improve the success rate of primary puncture,shorten the time from entering the room to successful puncture,and reduce the non-surgical time,which has a good clinical effect.