艾司氯胺酮静脉给药复合罗哌卡因骶管阻滞麻醉在腹股沟疝修补术患儿中的应用效果

Application effects of Esketamine intravenous administration combined with Ropivacaine caudal block anesthesia in children with inguinal hernia repair

目的:观察艾司氯胺酮静脉给药复合罗哌卡因骶管阻滞麻醉在腹股沟疝修补术患儿中的应用效果。方法:选取2022年9月至2023年1月于该院行腹股沟疝修补术的100例患儿进行前瞻性研究,按照随机数字表法将其分为对照组和观察组各50例。对照组采用七氟烷吸入复合罗哌卡因骶管阻滞麻醉,观察组采用艾司氯胺酮静脉给药复合罗哌卡因骶管阻滞麻醉。比较两组不同时间[麻醉前(T_(0))、麻醉后5 min(T_(1))、术毕(T_(2))、术后2 h(T_(3))]血流动力学指标(心率、呼吸频率、平均动脉压)水平、不同时间(术毕和术后6、12 h)炎性应激指标[皮质醇(Cor)、C反应蛋白(CRP)、白细胞介素-6(IL-6)]水平、临床指标(麻醉起效时间、住院时间、术后睁眼时间、麻醉恢复室停留时间)水平、术后不同时间(术后2、4、6 h)疼痛[Wong-Baker面部表情量表(WBS)]评分,以及不良反应发生率。结果:T_(1)、T_(2)时,两组心率、呼吸频率、平均动脉压水平均低于T_(0)时,但观察组T_(1)、T_(2)、T_(3)时心率、呼吸频率、平均动脉压水平均高于对照组,差异有统计学意义(P<0.05);术后6、12 h,观察组Cor、CRP、IL-6水平均低于对照组,差异有统计学意义(P<0.05);观察组术后睁眼时间、麻醉恢复室停留时间均短于对照组,差异有统计学意义(P<0.05);术后2、4、6 h,观察组WBS评分均低于对照组,差异有统计学意义(P<0.05);两组麻醉起效时间、住院时间和不良反应发生率比较,差异均无统计学意义(P>0.05)。结论:艾司氯胺酮静脉给药复合罗哌卡因骶管阻滞麻醉应用于腹股沟疝修补术患儿可稳定血流动力学指标水平,降低术后炎性应激指标水平和疼痛评分,缩短术后睁眼时间和麻醉恢复室停留时间,效果优于七氟烷吸入复合罗哌卡因骶管阻滞麻醉。

Objective:To observe application effects of Esketamine intravenous administration combined with Ropivacaine caudal block anesthesia in children with inguinal hernia repair.Methods:A prospective study was conducted on 100 children who underwent inguinal hernia repair in this hospital from September 2022 to January 2023.They were divided into control group and observation group according to the random number table method,50 cases in each group.The control group was treated with Sevoflurane inhalation combined with Ropivacaine caudal block anesthesia,while the observation group was treated with Esketamine intravenous administration combined with Ropivacaine caudal block anesthesia.The hemodynamic index levels(heart rate,respiratory rate,mean arterial pressure)at different time points[before anesthesia(T_(0)),5 min after anesthesia(T_(1)),end of the surgery(T_(2)),2 h after the surgery(T_(3))],the inflammatory stress index levels[cortisol(Cor),C-reactive protein(CRP),interleukin-6(IL-6)]at different time points(end of the surgery and 6,12 h after the surgery),the clinical indexes(onset time of anesthesia,hospitalization time,postoperative eye opening time,anesthesia recovery room stay time)levels,the postoperative pain[Wong-Baker facial expression scale(WBS)]scores at different time points(2,4,6 h after the surgery),and the incidence of adverse reactions were compared between the two groups.Results:At T_(1) and T_(2),the levels of heart rate,respiratory rate and mean arterial pressure of the two groups were lower than those at T_(0);the levels of heart rate,respiratory rate and mean arterial pressure of the observation group were higher than those of the control group at T_(1),T_(2) and T_(3);and the differences were statistically significant(P<0.05).At 6 and 12 h after the surgery,the levels of Cor,CRP and IL-6 in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The postoperative eye opening time and the anesthesia recovery room stay time in the observation group were shorter than those in the control group,and the differences were statistically significant(P<0.05).At 2,4,6 h after the surgery,the WBS scores of the observation group were lower than those of the control group,and the differences were statistically significant(P<0.05).However,there were no significant differences in the onset time of anesthesia,the hospitalization time and the incidence of adverse reactions between the two groups(P>0.05).Conclusions:Esketamine intravenous administration combined with Ropivacaine caudal block anesthesia in the children with inguinal hernia repair can stabilize the levels of hemodynamic indexes,reduce the levels of postoperative inflammatory stress indexes and the pain scores,and shorten the postoperative eye opening time and the anesthesia recovery room stay time.Moreover,it is superior to Sevoflurane inhalation combined with Ropivacaine caudal block anesthesia.