小剂量艾司氯胺酮在缓解小儿扁桃体切除术麻醉患儿疼痛程度及预防不良反应中的应用

Application of low-dose esketamine in relieving pain degree and preventing adverse reactions in children undergoing tonsillectomy anesthesia

目的探究小剂量艾司氯胺酮在缓解小儿扁桃体切除术麻醉患儿疼痛程度及预防不良反应中的应用效果。方法选取2020年1月至2021年12月赣州市妇幼保健院接诊的80例小儿扁桃体切除术麻醉患儿作为研究对象,采用随机抽签法分为对照组与观察组,每组40例。对照组行丙泊酚+舒芬太尼+苯磺酸顺阿曲库铵常规麻醉诱导,观察组在对照组基础上联合小剂量艾司氯胺酮麻醉,比较两组血流动力学、疼痛程度、不良反应发生情况、麻醉术后恢复情况。结果手术开始即刻(T3),对照组心率(HR)、平均动脉压(MAP)均高于手术开始3 min(T1)、手术开始6min(T2)、手术结束即刻(T4),且T4,对照组HR低于T2,差异有统计学意义(P<0.05);T2、T4,观察组MAP、HR均低于T1,但T3、T4高于T2,T4低于T3,差异有统计学意义(P<0.05)。T2、T4,观察组MAP、HR均低于对照组,T3,观察组HR低于对照组,差异有统计学意义(P<0.05)。拔管后20min(t2)~拔管后1h(t4),对照组儿童疼痛行为量表(FLACC)评分均低于拔管后10min(t1),拔管后0.5 h(t3)、t4低于T2,差异有统计学意义(P<0.05);t2~t4,观察组FLACC评分均高于t1,t3高于t2,t4低于t3,差异有统计学意义(P<0.05)。t1~t4,观察组FLACC评分均低于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率为7.50%,低于对照组的27.50%,差异有统计学意义(P<0.05)。观察组睁眼时间、吞咽反射恢复时间、拔管时间均短于对照组,差异有统计学意义(P<0.05)。结论小剂量艾司氯胺酮的辅助效果更好,可使患儿获取稳定、持久的麻醉效果,且不影响血流动力学变化,还可进一步减轻疼痛症状,及减少不良反应发生情况,促进麻醉后恢复进程。

Objective To explore the application effect of low-dose esketamine in relieving pain and preventing adverse reactions in children dergoing tonsillectomy anesthesia.Methods 80 children undergoing tonsillectomy anesthesia in Ganzhou Maternal and Child Health Hospital January 2020 to December 2021 were selected as the research subjects,they were divided into the control group and the observation group by dom drawing method,with 40 cases in each group.The control group was given propofol+sufentanil+cisatracurium besylate routine anesthesia in-duction,and the observation group was combined with low-dose esketamine anesthesia on the basis of the control group.The hemodynamics,pain degree,adverse reactions and postoperative recovery of anesthesia were compared between the two groups.Results At immediately after surgery(T3),the heart rate(HR)and mean arterial pressure(MAP)in the control group were higher than those at 3 min after the surgery(T1),6 min after the surgery(T2),immediately after the surgery(T4),and at T4,the HR in the control group was lower than that at T2,the differences were statistically significant(P<0.05);at T2 and T4,the MAP and HR in the observation group were lower than those at T1,but those at T3 and T4 were higher than those at T2,and those at T4 were lower than those at T3,the differences were statistically significant(P<0.05).At T2 and T4,the MAP and HR in the observation group were lower than those in the control group,at T3,the HR in the observation group was lower than that in the control group,and the differences were statistically significant(P<0.05).At 20 min after extubation(t2)-1 h after extubation(t4),the the face,legs,activity,cry,conso-lability behavioral tool(FLACC)scores in the control group were lower than those at 10 min after extubation(t1),0.5 h after extubation(t3)and t4 were lower than those at t2,and the differences were statistically significant(P<0.05);at t2-t4,the FLACC scores in the observation group were higher than those at t1,t3 was higher than t2,and t4 was lower than t3,the differences were statistically significant(P<0.05).At t1-t4,the FLACC scores in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The incidence of adverse reactions in the observation group was 7.50%,which was lower than 27.50%in the control group,and the difference was statistically sig-nificant(P<0.05).The eye opening time,swallowing reflex recovery time and extubation time in the observation group were shorter than those inthe control group,and the differences were statistically significant(P<0.05).Conclusion The auxiliary effect of low-dose esketamine is better,which can enable children to obtain a stable and lasting anesthetic effect without affecting hemodynamic changes,it can further alleviate pain symptoms,re-duce the occurrence of adverse reactions,and promote the recovery process after anesthesia.