艾司氯胺酮对扁桃体腺样体切除病儿苏醒期躁动影响OA
Effect of esketamine on emergence agitation after tonsillectomy and adenoidectomy in children
目的 探讨小剂量艾司氯胺酮苏醒期预先镇痛对扁桃体腺样体联合切除术后病儿苏醒期躁动(EA)的影响.方法 选取择期在全身麻醉下行扁桃体腺样体联合切除术病儿52例,随机分为艾司氯胺酮组(k组)和对照组(c组),每组26例.两组病儿均采用全凭静脉麻醉,给予戊乙奎醚0.01 mg/kg、舒芬太尼0.4 μg/kg、丙泊酚2～3 mg/kg、罗库溴铵0.6 mg/kg麻醉诱导,术中给予丙泊酚5～6 mg/(kg·h)和瑞芬太尼0.15～0.20 μg/(kg·min)维持麻醉,手术结束后停药,k组病儿缓慢静脉推注艾司氯胺酮0.2 mg/kg,c组静推生理盐水2 mL.采用小儿麻醉苏醒期躁动量表(PAED)及儿童疼痛评估量表(FLACC)对病儿的EA程度和疼痛程度进行评价.比较两组病儿术中镇痛镇静药物用量、呼吸恢复时间、睁眼时间、拔管时间,麻醉前和拔管即刻平均动脉压(MAP)和心率(HR)变化,拔管后10、20 min PAED评分,拔管后15 min FLACC评分和苏醒期不良反应发生情况.结果 两组病儿术中镇痛镇静药物用量、手术时长、呼吸恢复时间、睁眼时间、拔管时间、PACU停留时间、麻醉前MAP和HR、不良反应发生率差异无统计学意义(P＞0.05).k组病儿清醒后拔管即刻HR低于麻醉前,拔管后10 min及20 min时PAED评分、拔管后15 min FLACC评分、EA发生率、疼痛发生率与c组比较明显降低,差异均有统计学意义(t=-3.684～3.195,x2=4.952、5.650,P＜0.05).结论 0.2 mg/kg艾司氯胺酮苏醒期预先镇痛能有效降低扁桃体腺样体联合切除术病儿EA发生率.
Objective To investigate the effect of preemptive analgesia with low-dose esketamine during the awakening pe-riod on emergence agitation(EA)after tonsillectomy and adenoidectomy in children.Methods A total of 52 children who under-went elective tonsillectomy and adenoidectomy under general anesthesia were enrolled and randomly divided into esketamine group(group k)and control group(group c),with 26 children in each group.The children in both groups received total intravenous anes-thesia,with penehyclidine 0.01 mg/kg,sufentanil 0.4 μg/kg,propofol 2-3 mg/kg,and rocuronium 0.6 mg/kg for induction of anesthesia and propofol 5-6 mg/(kg·h)and remifentanil 0.15-0.20 μg/(kg·min)for intraoperative maintenance of anesthesia,and all anesthetic agents were discontinued upon completion of the surgical procedure.The children in group k were given slow in-travenous injection of 0.2 mg/kg esketamine,and those in group c were given intravenous injection of 2 mL normal saline.The Pe-diatric Anesthesia Emergence Delirium(PAED)scale and the Face,Legs,Activity,Cry and Consolability(FLACC)scale were used to assess the severity of EA and pain in children.The two groups were compared in terms of the amount of analgesic and seda-tive drugs used during surgery,time to recovery of respiration,time to eye opening,extubation time,mean arterial pressure(MAP)and heart rate(HR)before anesthesia and immediately after extubation,PAED score at 10 and 20 min after extubation,FLACC score at 15 min after extubation,and other adverse reactions.Results There were no significant differences between the two groups in the amount of analgesic and sedative drugs used during surgery,time of operation,time to recovery of respiration,time to eye opening,extubation time,the length of stay in the postanesthesia care unit,MAP and HR before anesthesia,and the incidence rate of adverse reactions(P＞0.05).The children in group k had a significantly lower HR immediately after extubation,and compared with group c,The children in group k had significantly lower PAED score at 10 and 20 min after extubation,lower FLACC score at 15 min after extubation,and lower incidence rates of EA and pain(t=-3.684 to 3.195,x2=4.952,5.650,P＜0.05).Conclusion Preemptive analgesia with 0.2 mg/kg esketamine can effectively reduce the incidence rate of EA in children undergoing tonsillectomy and adenoidectomy.
于潇嵘;董河
青岛大学附属医院麻醉科,山东青岛 266003青岛大学附属医院麻醉科,山东青岛 266003
医药卫生
苏醒谵妄艾司氯胺酮镇痛扁桃体切除术腺样体切除术儿童
emergence deliriumesketamineanalgesiaton-sillectomyadenoidectomychild
《青岛大学学报（医学版）》 2026 (2)
208-212,5
山东省卫健医疗管理研究中心科研项目(WYK-TG2023Z003)
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