艾司氯胺酮混合氢吗啡酮自控静脉镇痛对患儿术后睡眠质量的影响

Effect of patient-controlled intravenous analgesia with esketamine mixed with hydromorphone on postoperative sleep quality in pediatric patients

目的:评价艾司氯胺酮混合氢吗啡酮自控静脉镇痛对患儿术后睡眠质量的影响。方法:本研究为前瞻性随机对照研究。2023年1月至11月本院择期全身麻醉腹部手术后自控静脉镇痛患儿100例,性别不限,年龄4~12岁,BMI 13~26 kg/m^(2),ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为艾司氯胺酮混合氢吗啡酮组(EH组)和氢吗啡酮组(H组),每组50例。EH组镇痛泵药物:艾司氯胺酮1 mg/kg混合氢吗啡酮0.1 mg/kg,H组镇痛泵药物:氢吗啡酮0.2 mg/kg,均加入0.9%氯化钠溶液,稀释至100 ml。采用匹兹堡睡眠质量指数量表,通过患儿或监护人评估术前睡眠质量;术后1~3 d晨采用数字等级评分(NRS)评估术后前3晚睡眠质量。术后24和48 h时行FLACC疼痛评分,记录术后48 h内氢吗啡酮消耗量、术后恶心、呕吐、瘙痒、谵妄等不良反应的发生情况。 结果:与H组比较,EH组术后第1晚NRS升高,睡眠质量差比率下降( P<0.05),第2和3晚NRS和睡眠质量差比率差异无统计学意义( P>0.05),术后24和48 h时FLACC疼痛评分和术后48 h内氢吗啡酮消耗量降低( P<0.05);2组患儿术后不良反应发生率比较差异无统计学意义( P>0.05)。 结论:艾司氯胺酮混合氢吗啡酮自控静脉镇痛可改善患儿术后睡眠质量。

Objective To evaluate the effect of patient-controlled intravenous analgesia(PCIA)with esketamine mixed with hydromorphone on the postoperative sleep quality in pediatric patients.Methods This was a prospective randomised controlled study.One hundred pediatric patients of both sexes,aged 4-12 yr,with a body mass index of 13-26 kg/m^(2),of American Society of Anesthesiologists Physical Status classificationⅠorⅡ,undergoing elective abdominal surgery with general anesthesia,who agreed to use postoperative patient-controlled intravenous analgesia in our hospital from January to November 2023,were divided into esktamine mixed with hydromorphone group(EH group)and hydromorphone group(H group),with 50 patients in each group.PCIA solution contained esketamine 1 mg/kg and hydromorphon 0.1 mg/kg in 100 ml of 0.9%sodium chloride in EH group and hydromorphone 0.2 mg/kg in 100 ml of 0.9%sodium chloride in H group.The Pittsburgh Sleep Quality Index was used to evaluate the preoperative sleep quality by asking pediatric patients themselves or their guardians.On the morning of 1-3 days after surgery,the numeric rating scale(NRS)was used to evaluate the sleep quality of the first 3 nights after surgery.At 24 and 48 h after surgery,the FLACC pain scale was used to evaluate the intensity of pain.The consumption of hydromorphone within 48 h after surgery and the incidence of postoperative adverse reactions such as nausea,vomiting,itching and delirium were recorded.Results Compared with group H,the NRS score was significantly increased on the 1st postoperative night,the ratio of poor sleep quality was decreased(P<0.05),and no significant change was found in the NRS score on the 2nd or 3rd postoperative night and ratio of poor sleep quality(P>0.05),and the FLACC pain scale score at 24 and 48 h after surgery and consumption of hydromorphone within 48 h after surgery were decreased in group EH(P<0.05).There was no significant difference in the incidence of postoperative adverse reactions between the two groups(P>0.05).Conclusions PCIA with esketamine mixed with hydromorphone can improve the postoperative sleep quality in pediatric patients.