不同亚麻醉剂量艾司氯胺酮对扁桃体切除术患儿苏醒期躁动的影响

Effects of Different Subanesthetic Doses of Esketamine on Emergence Agitation in Children Undergoing Tonsillectomy

目的探讨不同亚麻醉剂量艾司氯胺酮对扁桃体切除术后患儿苏醒期躁动(EA)发生率及麻醉后恢复情况的影响。方法选取2021年8月至2022年1月在雅安市人民医院行全麻扁桃体切除术患儿80例,采用随机数字表法将患儿随机分为艾司氯胺酮0.25 mg/kg组(A组)和艾司氯胺酮0.50 mg/kg组(B组)。全身麻醉诱导时A组静脉注射0.25 mg/kg艾司氯胺酮,B组静脉注射0.50 mg/kg艾司氯胺酮。记录两组患儿各时间点的心率(HR)、平均动脉压(MAP)、脉搏氧饱和度(SpO2);比较两组患儿术后EA发生率、严重EA发生率及术后中重度疼痛发生率;记录苏醒时间、拔管时间、麻醉恢复室(PACU)停留时间及不良事件发生情况。结果两组患儿EA发生率(2.56%vs 7.89%)、严重EA发生率(2.56%vs 5.26%)和中重度疼痛发生率(15.38%vs 10.52%)比较,差异无统计学意义(P>0.05);A组苏醒时间[(15.05±3.51)min vs(20.05±4.64)min]和拔管时间[(12.54±4.34)min vs(16.66±7.07)min]较B组短(P<0.05);两组患儿PACU停留时间、不良反应发生率、血流动力学比较差异无统计学意义(P>0.05)。结论0.25 mg/kg和0.50 mg/kg艾司氯胺酮均可有效降低全身麻醉扁桃体切除术患儿EA,但0.25 mg/kg的艾司氯胺酮苏醒时间和拔管时间更短。

Objective To investigate the effects of different subanesthetic doses of esketamine on the incidence of emergence agitation(EA)and the recovery from anesthesia in children after tonsillectomy.Methods A total of 80 children who underwent general anesthesia tonsillectomy in Ya'an People's Hospital from August 2021 to January 2022 were selected.They were divided into esketamine 0.25 mg/kg group(Group A)and esketamine 0.5 mg/kg group(Group B)by random number table method.Group A and Group B received 0.25 mg/kg and 0.5 mg/kg of esketamine injection intravenously during induction of general anesthesia,respectively.The heart rate(HR),mean arterial pressure(MAP),and pulse oximetry(SpO2)of children in both groups were recorded at each time point.The incidence of EA,severe EA,and moderate to severe pain in both groups were compared.The time of awaking,time of extubation,length of stay in the postanesthesia care unit(PACU),and the postoperative incidence of adverse events were recorded.Results There was no significant difference in the incidence of EA(2.56%vs 7.89%),severe EA(2.56%vs 5.26%),and moderate to severe pain(15.38%vs 10.52%)between the two groups(P>0.05).The time of awaking[(15.05±3.51)min vs(20.05±4.64)min]and extubation[(12.54±4.34)min vs(16.66±7.07)min]in Group A were shorter than those in Group B(P<0.05).There was no significant difference in the length of stay in the PACU,postoperative incidence of adverse reactions,and hemodynamics between the two groups(P>0.05).Conclusion Both intravenous injection of 0.25 mg/kg and 0.5 mg/kg esketamine are equally effective in reducing the incidence of EA in children undergoing general anesthesia tonsillectomy,but children injected with 0.25 mg/kg esketamine have shorter time of awaking and extubation.