扁桃体低温等离子消融术后患儿应用艾司氯胺酮的PCIA效果观察

Observation of PCIA Effect of Esketamine after Low Temperature Plasma Ablation of Tonsil in Children

目的:探究小儿扁桃体低温等离子消融术后应用艾司氯胺酮的患儿自控静脉镇痛(PCIA)效果。方法:选择巩义市人民医院2020年1月至2022年6月实施扁桃体低温等离子消融术治疗的60例患儿,采用随机数字表法分为对照组和观察组,各30例。观察组PCIA泵配方为艾司氯胺酮+氟比洛芬酯+帕洛诺司琼;对照组PCIA泵配方为舒芬太尼+氟比洛芬酯+帕洛诺司琼。比较两组患儿临床麻醉相关指标、视觉模拟评分法(VAS)评分、动脉血氧饱和度(SpO2)、不良反应发生情况。结果:观察组麻醉诱导时哭闹患儿占比、苏醒期追加丙泊酚患儿占比,Aono评分、患儿疼痛与舒适量表(FLACC)疼痛评分均低于对照组,差异具有统计学意义(P <0.05)。观察组患儿术后各时段VAS评分均低于对照组,差异具有统计学意义(P <0.05)。术后2 h、4 h,观察组患儿SpO2高于对照组,差异具有统计学意义(P <0.05);术后12 h、24 h,两组患儿SpO2比较,差异无统计学意义(P> 0.05)。两组患儿术后不良反应发生率比较,差异无统计学意义(P> 0.05)。结论:小儿扁桃体低温等离子消融术后应用艾司氯胺酮有良好的镇痛效果,术后短期呼吸循环能力稳定,且不会增加不良反应发生率。

Objective To investigate the effect of esketamine on patient-controlled intravenous analgesia(PCIA)after low temperature plasma ablation of tonsil in children. Methods Sixty children who underwent low temperature plasma ablation of tonsil in Gongyi People's Hospital from January 2020 to June 2022 were selected and divided into a control group and an observation group by random number table method, with 30 cases in each group. The PCIA pump formula of the observation group was esketamine + Flurbiprofen ester + Palonosetron;The PCIA pump formula of the control group was Sufentanil + Flurbiprofen ester + Palonosetron. Clinical anesthesia related indexes, visual analogue scale (VAS) score, arterial oxygen saturation (SpO2) and adverse reactions were compared between the two groups. Results The proportion of crying children during anesthesia induction and children supplemented with propofol during recovery, Aono score and face legs activity crying consolability (FLACC) pain score in the observation group were lower than those in the control group, and the differences were statistically significant (P < 0.05). The VAS scores in the postoperative period in the observation group were lower than those in the control group, and the differences were statistically significant (P < 0.05). At 2 hours and 4 hours after operation, SpO2 in the observation group was higher than that in the control group, the difference was statistically significant (P < 0.05). There was no significant difference in SpO2 between the two groups at 12 hours and 24 hours after surgery (P > 0.05). There was no significant difference in the incidence of postoperative adverse reactions between the two groups (P > 0.05). Conclusion The application of esketamine after low temperature plasma ablation of tonsil in children has a good analgesic effect, and the short-term respiratory circulation ability is stable after surgery, and does not increase the occurrence of adverse reactions.