艾司氯胺酮与右美托咪定辅助全麻对小儿腺样体扁桃体切除术PAED评分、苏醒质量和不良反应的影响

Effects of Esketamine and Dexmedetomidine Assisted General Anesthesia on PAED Score,Quality of Recovery and Adverse Reactions in Children Undergoing Adenotonsillectomy

目的探讨艾司氯胺酮与右美托咪定辅助全麻对小儿腺样体扁桃体切除术麻醉苏醒期躁动量表(PAED)评分、苏醒质量和不良反应的影响。方法选取2021年10月—2023年10月收治的138例行腺样体扁桃体切除术患儿,采用简单随机数表法分为E组与M组,各69例。2组均予全麻,麻醉诱导前,E组予以艾司氯胺酮静脉注射,M组予以右美托咪定静脉泵注。记录改良Aldrete评分,比较诱导前(T0)、诱导后(T1)、插管时(T2)、腺样体扁桃体剥离时(T3)、拔管时(T4)平均动脉压(MAP)、心率(HR),检测术前、术后1 d应激指标[5-羟色胺(5-HT)、去甲肾上腺素(NE)、肾上腺素(E)、皮质醇(Cor)],记录进入麻醉后恢复室30 min内的最大PAED评分及疼痛行为评分量表(FLACC)评分,记录2组麻醉不良反应。结果E组改良Aldrete评分高于M组(P<0.01)。T0~T4时,E组MAP、HR呈先升高后降低趋势,M组MAP、HR呈先降低后升高趋势,且T2、T3时E组MAP、HR均高于M组(P<0.05)。术后1 d,2组5-HT、NE、E和Cor水平高于术前,但E组低于M组(P<0.05)。E组PAED评分、FLACC评分均低于M组(P<0.05)。2组不良反应发生率比较差异不显著(P>0.05)。结论较右美托咪定,艾司氯胺酮辅助全麻可以降低腺样体扁桃体切除术患儿PAED评分、提高苏醒质量,减轻血流动力学波动和应激性损伤。

Objective To investigate the effects of Esketamine and Dexmedetomidine assisted general anesthesia on pediatric anesthesia emergence delirium scale(PAED)score,quality of recovery and adverse reactions in children undergoing adenoidectomy and tonsillectomy.Methods A total of 138 children undergoing adenoidectomy and tonsillectomy treated from October 2021 to October 2023 were selected and divided into group E(n=69)and group M(n=69)using simple random number table method.Both groups were given general anesthesia.Before induction of anesthesia,Esketamine was injected intravenously in group E and Dexmedetomidine was injected intravenously in group M.The modified Aldrete score were recorded,and the mean arterial pressure(MAP)and heart rate(HR)were compared before induction(T0),after induction(T1),during intubation(T2),during adenoidectomy(T3)and at extubation(T4).The stress indexes[5-hydroxytryptamine(5-HT),norepinephrine(NE),epinephrine(E),cortisol(Cor)]were detected before and at 1 day after surgery.The maximum PAED score and the revised Face,Legs,Activity,Cry and Consolability scale(FLACC)score within 30 min after entering the recovery room following anesthesia were recorded,and the adverse reactions of anesthesia in the two groups were recorded.Results The modified Aldrete score of group E was higher than that of group M(P<0.01).At T0-T4,MAP and HR in group E increased first and then decreased,while MAP and HR in group M decreased first and then increased.At T2 and T3,MAP and HR in group E were higher than those in group M(P<0.05).The levels of 5-HT,NE,E and Cor in the two groups were higher than those before surgery,which,however,were lower in E group than in M group(P<0.05).The scores of PAED and FLACC in group E were lower than those in group M(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Compared with Dexmedetomidine,Esketamine can reduce PAED score,improve recovery quality,reduce hemodynamic fluctuation and stress injury in children after adenoidectomy and tonsillectomy.