艾司氯胺酮复合丙泊酚用于孤独症患儿内镜肠道植管术麻醉的效果

Efficacy of esketamine combined with propofol for colonic transendoscopic enteral tubing in pediatric patients with autism

目的评价艾司氯胺酮复合丙泊酚用于孤独症患儿内镜肠道植管术(TET)麻醉的效果。方法选择2022年10月至2023年8月行结肠途径TET的孤独症患儿60例,性别不限,年龄3~12岁,体质量15~45 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为2组(n=30):生理盐水+丙泊酚组(NP组)和艾司氯胺酮+丙泊酚组(EP组)。NP组静脉注射生理盐水10 ml,EP组静脉注射艾司氯胺酮0.3 mg/kg,均于30 s后静脉注射丙泊酚2.0 mg/kg。改良警觉/镇静(MOAA/S)评分≤2分时行TET,若镇静深度不够则追加丙泊酚0.5~1.0 mg/kg,维持MOAA/S评分≤2分至术毕。记录患儿TET过程中的体动反应程度。记录注射痛、丙泊酚总用量、手术时间、自然苏醒时间、手术完成情况;记录术中及苏醒期呼吸抑制、恶心呕吐、低血压、心动过缓、术后躁动等不良反应发生情况。结果与NP组比较,EP组术中体动程度更轻,丙泊酚总用量、注射痛及术中低血压的发生率降低(P<0.05),自然苏醒时间及恢复期间不良反应发生率差异无统计学意义(P>0.05)。结论艾司氯胺酮(0.3 mg/kg)复合丙泊酚(2.0 mg/kg)可安全、有效地用于孤独症患儿TET,在不进行早期唤醒的复苏策略中,艾司氯胺酮并未增加复苏期间不良反应发生风险。

Objective To evaluate the efficacy of esketamine combined with propofol for colonic transendoscopic enteral tubing(TET)in pediatric patients with autism.Methods Sixty pediatric patients with autism of both sexes,aged 3-12 yr,weighing 15-45 kg,of American Society of Anesthesiologists Physical Status classificationⅠorⅡ,who underwent painless transendoscopic enteral tubing(TET)from October 2022 to August 2023,were selected and divided into 2 groups(n=30 each)by a random number table method:normal saline+propofol group(group NP)and esketamine+propofol group(group EP).In group NP,normal saline 10 ml was intravenously injected,and 30 s later propofol 2.0 mg/kg was given.In group EP,esketamine 0.3 mg/kg(diluted to 10 ml in normal saline)was intravenously injected,and 30 s later propofol 2.0 mg/kg was given.TET was performed when the Modified Observer′s Assessment of Alertness/Sedation Scale score≤2.Propofol 0.5-1.0 mg/kg was added if the sedation depth was not enough,and the Modified Observer′s Assessment of Alertness/Sedation Scale score was maintained≤2 until the end of surgery.The degree of body movement during TET was observed and recorded.The injection pain during induction,total consumption of propofol,operation time,spontaneous emergence time,and completion of operation were recorded.Adverse reactions such as respiratory depression,nausea and vomiting,hypotension,bradycardia,and postoperative agitation were recorded during operation and in the emergence period.Results Compared with group NP,the degree of intraoperative body movement was significantly lighter,the total consumption of propofol and incidence of injection pain and intraoperative hypotension were significantly lower,and no significant change was found in the spontaneous emergence time and incidence of adverse reactions during recovery in group EP(P<0.05).Conclusions Esketamine(0.3 mg/kg)combined with propofol(2.0 mg/kg)can be safely and effectively used for colonic TET in pediatric patients with autism,and esketamine does not increase the risk of adverse reactions during resuscitation in a resuscitation strategy without early awakening.