小剂量艾司氯胺酮在儿童扁桃体腺样体切除术中的应用安全性分析

Application and safety of low-dose esketamine in children undergoing tonsillectomy and adenoidectomy

目的探究小剂量艾司氯胺酮治疗扁桃体腺样体切除术儿童的应用有效性,进行安全性分析。方法回顾性选取浙江省丽水市人民医院2023年9月至12月收治的298例扁桃体、腺样体肥大患儿,2组患儿均进行扁桃体腺样体切除术及全身麻醉,根据患儿情况、家长自愿原则分为研究组(150例,采用小剂量艾司氯胺酮复合全身麻醉,以0.2~0.3 mg/kg静脉注射麻醉诱导,以0.2 mg·kg^(-1)·h^(-1)静脉泵注麻醉维持)和对照组(148例,采用等量0.9%氯化钠注射液作为安慰剂)。2组其他麻醉诱导及维持所用药物均相同。采用倾向性匹配评分法排除混杂因素后2组各有125例患者,比较2组患者麻醉前、诱导后5 min、气管插管时、手术开始后10 min、术毕的平均动脉压(MAP)、心率(HR)及入麻醉恢复室(PACU)后10 min、30 min的疼痛评分量表(FLACC)评分、儿童麻醉苏醒期躁动(EA)评分量表(PAED)评分,对比2组手术相关指标、麻醉药物使用情况及术后不良反应。结果研究组患儿围术期不同时间点的MAP、HR比较差异无统计学意义(P>0.05),在诱导后5 min、气管插管时、手术开始后10 min,对照组患儿的MAP、HR均较麻醉前降低,且均低于研究组(P<0.05);研究组患儿入PACU后10 min、30 min的FLACC及PAED评分均低于对照组(P<0.05);研究组术中瑞芬太尼用量以及苏醒期追加丙泊酚例数均少于对照组,入PACU时间短于对照组(P<0.05);研究组不良反应总发生率低于对照组(P<0.05)。结论小剂量艾司氯胺酮在患儿扁桃体腺样体切除术中的应用有效性显著,在不影响手术恢复的情况下,更能维持患儿血流动力学稳定,减轻患者疼痛,减少EA发生及麻醉药物用量,且具备安全性,有临床应用价值。

Objective To explore the application effectiveness of low-dose esketamine in the treatment of children undergoing tonsillectomy and adenoidectomy,and peform safety analysis.Methods A total of 298 children with tonsil and adenoid hypertrophy admitted to Lishui People's Hospital were retrospectively selected from September 2023 to December 2023.All the children received tonsillectomy and adenoidectomy and general anesthesia.According to the condition of children and the voluntary principle of the parents,they were divided into a study group(n=150)and a control group(n=148).The study group was treated with low-dose esketamine combined with general anesthesia,with 0.2-0.3 mg/kg intravenous injection,followed by 0.2 mg·kg^(-1)·h^(-1)intrave-nous infusion anesthesia maintenance;the control group was treated with an equal amount of normal saline.Other drugs used for anesthesia induction and maintenance were the same in the two groups.There were 125 patients in each group after the confounding factors were excluded by propensity matching score.The mean arterial pressure(MAP)and heart rate(HR)before anesthesia,at 5 min after induction,at the time of tracheal intubation,at 10 min after the start of surgery and at the end of surgery,Face,Legs,Activity,Crying,Consolability(FLACC)score and Pediatric Anesthesia Emergence Delirium(PAED)score at 10 min and 30 min after entering the postanesthesia care unit(PACU),surgery-related indicators,anesthetic drug use and postoperative adverse reactions were com-pared between groups.Results There were no statistically statistical differences in MAP and HR at different time points during the perioperative period in study group(P>0.05).At 5 min after induction,tracheal intubation and 10 min after the start of surgery,the MAP and HR in control group were declined than those before anesthesia,and were lower than those in study group(P<0.05).The FLACC score and PAED score in study group at 10 min and 30 min after entering the PACU were lower than those in control group(P<0.05).Compared with control group,the dosage of intraoperative remifentanil and the number of cases with additional propofol during recovery in study group were less,and the PACU stay was shorter(P<0.05).The total incidence rate of adverse reactions in study group was lower than that in control group(P<0.05).Conclusion Low-dose esketamine has significant ap-plication effectiveness during tonsillectomy and adenoidectomy in children.Without affecting the recovery of surgery,it can maintain the hemodynamic stability of children,relieve the pain,and reduce the occurrence of EA and the dosage of anesthetic drug,and it has safety and clinical application value.