低剂量艾司氯胺酮对学龄前儿童日间斜视手术全身麻醉苏醒期谵妄的影响

Effects of low-dose esketamine on emergence delirium in preschool children undergoing daytime strabismus surgery

目的:评估在学龄前儿童日间斜视手术中低剂量艾司氯胺酮复合诱导对全身麻醉苏醒期谵妄(ED)的影响。方法:选择176例实施斜视矫正术的学龄前儿童(3~7岁),采用随机数排秩法分为对照组和艾司氯胺酮组各88例,全身麻醉诱导时对照组给予丙泊酚2.5 mg/kg,艾司氯胺酮组给予艾司氯胺酮0.5 mg/kg和丙泊酚1 mg/kg,其余麻醉方法相同。患儿苏醒后记录儿童苏醒期谵妄(PAED)评分、ED发生率、补救镇静发生率、FLACC疼痛评分、苏醒时间、麻醉恢复室(PACU)停留时间以及术后第1、7和30天的术后不良行为改变(NPOBC)发生率。结果:与对照组比较,艾司氯胺酮组患儿PAED评分、ED发生率和PACU停留时间增加或延长(P<0.05)。术后第1、7和30天两组NPOBC发生率比较,差异无统计学意义(P=0.151)。两组患儿均未观察到苏醒期恶心呕吐、呼吸抑制和指脉氧饱和度<90%等不良事件的发生。结论:在学龄前儿童日间斜视手术中,低剂量艾司氯胺酮复合诱导可能会增加ED发生率。

Aim:To evaluate the effects of low-dose esketamine on emergence delirium(ED)in preschool children undergoing daytime strabismus surgery.Method:A total of 176 preschool children aged 3 to 7 years were assigned to either the control group or the esketamine group with 88 cases each according to random number ranking method.The control group received propofol at a dose of 2.5 mg/kg during general anesthesia induction,while the esketamine group received a combination of esketamine at a dose of 0.5 mg/kg and propofol at a dose of 1 mg/kg during induction,with other anesthesia methods remaining consistent across both groups.Upon regaining consciousness,pediatric anesthesia emergence delirium(PAED)score and incidence rate of ED were recorded along with other parameters such as rescue sedation rate,FLACC score,emergence time,length of stay in post-anesthesia care unit(PACU).The incidence rate for negative postoperative behavioral changes(NPOBC)on postoperative day 1,7,and 30 was recorded.Result:The esketamine group exhibited significantly higher PAED scores and incidence rate of ED as well as longer stays in PACU compared with the control group(P<0.05).There was no significant difference in NPOBC incidence rate between the 2 groups on postoperative day 1,7 or 30(P=0.151).No adverse events such as nausea,vomiting,respiratory depression or finger pulse oxygen saturation<90%were observed.Conclusion:Low-dose esketamine compound induction during general anesthesia may increase incidence of ED among preschool children undergoing daytime strabismus surgery.