艾司氯胺酮联合丙泊酚在儿童腹股沟疝手术的应用效果分析

Analysis on application effect of esketamine combined with propofol in inguinal hernia operation in children

目的探讨艾司氯胺酮联合丙泊酚在儿童腹股沟疝手术中的应用效果。方法选择2022年11月—2023年6月本院收治的拟行传统疝囊高位结扎术的住院患儿96例作为研究对象,年龄1~6岁,ASAⅠ~Ⅱ级。采用随机数表法将本院收治的患儿分为艾司氯胺酮组(E组)、芬太尼组(F组)和丙泊酚组(P组),每组各32例。E组、F组和P组分别在术者铺巾完成后静脉注射0.5 mg/kg艾司氯胺酮、1μg/kg芬太尼和1 mg/kg丙泊酚,5 min后用0.5%利多卡因1 mg/kg在手术侧行局麻后开始手术。每组均在入室后静脉持续泵注丙泊酚9~15 mg/(kg·h),术中根据患者体动情况及生命体征变化情况增减丙泊酚的泵注速度。记录入室前(T_(0))、试验药物给药后5 min(T_(1))、手术开始时(T_(2))、手术结束时(T_(3))、入恢复室时(T_(4))和患者苏醒时(T_(5))的心率(HR)、平均动脉压(MAP)。记录术中丙泊酚泵注剂量、手术时间、苏醒时间、恢复室滞留时间以及苏醒期躁动和疼痛评分(PAED评分)。记录三组呼吸抑制、苏醒期躁动、恶心呕吐、不自主体动等不良反应发生情况。结果最终完成研究92例,与E组相比,F组和P组丙泊酚泵注剂量显著减少(P<0.05)。P组的PAED评分与E组和F组相比明显增加(P<0.05)。T_(1)、T_(2)、T_(5)时,三组的HR差异有统计学意义(P<0.05)。T_(1)、T_(5)时三组的MAP差异有统计学意义(P<0.05)。与P组相比,E组不自主体动、呼吸抑制发生率明显降低(P<0.05)。三组其他不良反应发生率差异均无统计学意义(P>0.05)。结论0.5 mg/kg艾司氯胺酮联合丙泊酚用于儿童腹股沟疝手术,血流动力学稳定,不仅可降低丙泊酚的泵注剂量,而且可降低呼吸抑制和不自主体动等不良反应的发生率。

Objective To investigate the application effect of esketamine combined with propofol in inguinal hernia operation in children.Methods A total of 96 children who were planned to undergo traditional high ligation of hernia sac during November 2022 and June 2023 were enrolled as study subjects,they were aged 1-6 years,ASA grade Ⅰ or Ⅱ.The patients were randomly divided into esketamine group(group E),fentanyl group(group F)and propofol group(group P)according to random number table method,32 patients in each group.In groups E,F and P,0.5 mg/kg esketamine,1μg/kg fentanyl and 1 mg/kg propofol were injected intravenously,respectively.5 minutes later 0.5%lidocaine was used to local anesthesia on the operative side at the dose of 1 mg/kg,then the operation started.In each group,9~15 mg/(kg h)propofol was injected intravenously continuously after entry.During the operation,the pumping speed of propofol was increased or decreased according to the changes of patients'body movements and vital signs.Heart rate(HR)and mean arterial pressure(MAP)were recorded before entry(T_(0)),5 minutes after trial drug administration(T_(1)),at the beginning of surgery(T_(2)),at the end of surgery(T_(3)),at the time of entry to the recovery room(T_(4)),and at the time of patient awakening(T_(5)).The total amount of propofol pumping,operation time,recovery time,recovery room retention time,and agitation and pain score(PAED score)during recovery were recorded.The adverse reactions such as respiratory depression,restlessness,nausea and vomiting,and involuntary body movement were recorded in the three groups.Results In the end,92 cases completed the study.Compared with group E,the pump dose of propofol in groups F and P was significantly reduced(P<0.05).The PAED score of group P was significantly higher than that of groups E and F(P<0.05).At T_(1),T_(2) and T_(5),there were statistically significant differences in HR among the three groups(P<0.05).The MAP difference among the three groups at T_(1) and T_(5) was statistically significant(P<0.05).Compared with group P,the incidence of involuntary body movement and respiratory depression in group E was significantly decreased(P<0.05).There was no significant difference in the incidence of other adverse reactions among the three groups(P>0.05).Conclusions 0.5 mg/kg esketamine combined with propofol that applied in inguinal hernia surgery in children,can not only reduce the pump dose of propofol,but also reduce the incidence of adverse reactions,such as respiratory depression and involuntary body movement.