艾司氯胺酮静脉注射联合右美托咪定滴鼻在小儿疝气手术中的应用效果分析

Effect analysis of esketamine intravenous injection combined with dexmedetomidine nasal drops of hernia surgery in children

目的探讨艾司氯胺酮静脉注射联合右美托咪定滴鼻在小儿疝气手术中的应用效果。方法前瞻性选取2021年1月至2023年12月来延安市人民医院行疝气手术的患儿96例作为研究对象。按照随机数字表法将其分为低剂量组、高剂量组和对照组,每组各32例。3组均给予2μg/kg右美托咪定进行滴鼻,低剂量组患儿静脉注射0.5 mg/kg艾斯氯胺酮,高剂量组患儿静脉注射1 mg/kg艾斯氯胺酮,对照组患儿静脉注射等剂量的0.9%氯化钠溶液。比较3组患儿的自主呼吸时间、指令性睁眼时间、麻醉后监测治疗室停留时间,麻醉前(T_(1))、麻醉后10 min(T_(2))、手术开始后5 min(T_(3))、手术结束即刻(T_(4))、苏醒即刻(T_(5))的心率、平均动脉压水平,行为学合作评分、躁动评分,滴鼻后5、10、20、30 min的Ramsay镇静评分,术后4、12、24、48 h时的疼痛评分及苏醒期内的不良反应发生情况。结果低剂量组、高剂量组患儿的自主呼吸时间、指令性睁眼时间、麻醉后监测治疗室停留时间均明显短于对照组,差异均有统计学意义(P<0.05)。T_(2)~T_(5)时间点,低剂量组、高剂量组的心率、平均动脉压均明显低于对照组,差异均有统计学意义(P<0.05)。低剂量组、高剂量组的行为学合作评分均明显高于对照组,躁动评分均明显低于对照组,差异均有统计学意义(P<0.05)。滴鼻后10、20 min时,3组的Ramsay镇静评分明显较滴鼻后5 min高,滴鼻后20 min,3组的Ramsay镇静评分明显较滴鼻后10 min高,差异均有统计学意义(P<0.05)。滴鼻后10、20、30 min时,低剂量组、高剂量组的Ramsay镇静评分均明显高于对照组,差异均有统计学意义(P<0.05)。术后4、48 h时,3组的疼痛评分比较,差异均无统计学意义(P>0.05);术后12、24 h时,低剂量组、高剂量组的疼痛评分均明显低于对照组,差异均有统计学意义(P<0.05)。低剂量组与高剂量组组间以上各指标比较,差异均无统计学意义(P>0.05)。高剂量组患儿苏醒期内的不良反应发生率明显高于对照组,差异有统计学意义(P<0.05),对照组与低剂量组,低剂量组与高剂量组组间不良反应发生率比较,差异均无统计学意义(P>0.05)。结论右美托咪定滴鼻+静脉注射0.5mg/kg艾斯氯胺酮对小儿疝气手术的镇静效果更好,可稳定患儿的血流动力学,缩短患儿的自主呼吸时间、指令性睁眼时间、麻醉后监测治疗室停留时间,减少躁动、疼痛情况,安全性高。

Objective To explore the effect of intravenous esketamine combined with dexmedetomidine nasal drops of hernia surgery in children.Methods A total of 96 children who underwent hernia surgery in Yan'an People's Hospital from January 2021 to December 2023 were prospectively selected as the study subjects.According to the random number table method,they were divided into the low-dose group,the high-dose group and the control group,32 cases in each group.All three groups were given 2μg/kg dexmedetomidine nasal drops,the low-dose group was given 0.5 mg/kg esketamine,the high-dose group was given 1 mg/kg esketamine,and the control group was given equal volume of normal saline intravenically.The spontaneous breathing time,mandatory eye opening time,post-anesthesia monitoring treatment room stay time,the levels of heart rate and mean arterial pressure before anesthesia(T_(1)),10 min after anesthesia(T_(2)),5 min after the start of surgery(T_(3)),immediately after the end of surgery(T_(4))and immediately after recovery(T_(5)),behavioral cooperation score,agitation score,Ramsay sedation scores at 5,10,20 and 30 min after nasal drip,pain score at 4,12,24,48 h after surgery,and occurrence of adverse reactions during recovery were compared among the three groups.Results The spontaneous breathing time,mandatory eye opening time and post-anesthesia monitoring treatment room stay time in the low-dose group and the high-dose group were significantly shorter than those in the control group,and the differences were statistically significant(P<0.05).At T_(2)-T_(5),the heart rate and mean arterial pressure of the low-dose group and the high-dose group were significantly lower than those of the control group,and the differences were statistically significant(P<0.05).The behavioral cooperation scores of the low-dose group and the high-dose group were significantly higher than those of the control group,and the agitation scores were significantly lower than those of the control group,the differences were statistically significant(P<0.05).At 10 and 20 min after nasal drip,the Ramsay sedation scores of the three groups were significantly higher than those at 5 min after nasal drip,and at 20 min after nasal drip,the Ramsay sedation scores of the three groups were significantly higher than those at 10 min after nasal drip,the differences were statistically significant(P<0.05).At 10,20 and 30 min after nasal drip,the Ramsay sedation scores of the low-dose group and the high-dose group were significantly higher than those of the control group,and the differences were statistically significant(P<0.05).At 4 and 48 h after operation,there was no statistically significant difference being found in the comparison of the pain scores among the three groups(P>0.05).At 12 and 24 h after operation,the pain scores of the low-dose group and the high-dose group were significantly lower than those of the control group,and the differences were statistically significant(P<0.05).There were no statistically significant differences in the above indexes between the low-dose group and the high-dose group(P>0.05).The incidence of adverse reactions in the high-dose group was statistically significantly higher than that in the control group,and the difference was statistically significant(P<0.05),and there were no statistically significant differences in the comparison between the control group and the low-dose group,and between the low-dose group and the high-dose group(P>0.05).Conclusion Dexmedetomidine nasal drops plus intravenous injection of 0.5 mg/kg esketamine have a better sedative effect on hernia surgery in children,which can stabilize the hemodynamics of children,shorten the time of spontaneous breathing,the time of mandatory eye opening,and the time of stay in the treatment room after anesthesia,reduce agitation and pain,and have high safety.