艾司氯胺酮复合右美托咪定麻醉对小儿腹腔镜手术应激反应和复苏质量的影响

摘要/Abstract

摘要： 目的探讨艾司氯胺酮复合右美托咪定麻醉对小儿腹腔镜手术应激反应和复苏质量的影响。方法选取2021年1月—2022年1月在内蒙古自治区妇幼保健院收治的96例行腹腔镜下腹股沟斜疝疝囊高位结扎术的患儿作为研究对象,根据随机数表法把患儿分为联合组与对照组,每组48例。对照组给予艾司氯胺酮麻醉,联合组在对照组的基础上复合右美托咪定麻醉,比较联合组与对照组麻醉情况,不同时间点的血清肾上腺素、胰高血糖素含量变化,苏醒期躁动评分,术后7 d不良反应发生情况。结果两组麻醉起效时间比较,差异无统计学意义（P>0.05）,联合组氯胺酮用量、术后苏醒时间、术后住院时间均明显少于对照组,差异有统计学意义（P<0.05）。两组送回病房时血清肾上腺素、胰高血糖素含量均明显低于入手术室时,差异有统计学意义（P<0.05）,联合组血清肾上腺素、胰高血糖素含量明显低于对照组,差异有统计学意义（P<0.05）。联合组苏醒期躁动PAED评分明显低于对照组,差异有统计学意义（P<0.05）。术后7 d,两组不良反应发生率比较,差异无统计学意义（P>0.05）。结论艾司氯胺酮复合右美托咪定麻醉在小儿腹腔镜手术的应用能缓解应激反应,促进患儿苏醒与康复,减少氯胺酮用量,还可改善患儿苏醒期躁动情况,且不会增加不良反应的发生。

关键词: 艾司氯胺酮, 右美托咪定, 腹腔镜手术, 苏醒期躁动, 应激反应

Abstract: Objective To investigate the effect of esketamine combined with dexmedetomidine anesthesia on stress response and resuscitation quality in children undergoing laparoscopic surgery. Methods From January 2021 to January 2022, 96 cases of children who underwent laparoscopic high ligation of inguinal hernia sac in Maternal and Child Health Hospital of Inner Mongolia Autonomous Region were selected as research objects. Accorded to the 1:1 random number table, the children were divided into the combined group and the control group with 48 cases in each groups. The control group was anesthetized with ketamine, the combined group was anesthetized with dexmedetomidine on the basis of the control group, and the anesthesia conditions of the combined group and the control group were recorded, the changes of serum epinephrine and Glucagon levels at different time points, the scores of restlessness in the awakening period, and the occurrence of adverse reactions on the 7th day after operation. Results There were no significant difference in the onset time of anesthesia compared between the two groups (P>0.05). The recovery time, ketamine dosage, and hospital stay after surgery in the combined group were less than those in the control group(P<0.05). The content of serum adrenaline and glucagon in the two groups when they were sent back to the ward were significantly lower than that when they entered the operating room (P<0.05), and the content of serum adrenaline and glucagon in the combined group were also significantly lower than that in the control group (P<0.05). The PAED score of restlessness in the combined group were significantly lower than that in the control group (P<0.05). The incidence of adverse reactions, such as nausea and vomiting, respiratory depression, tachycardia, and hypoxemia at 7 d after the combination group, was 4.17%, which was not significant compared with 8.33% in the control group (P>0.05). Conclusion The application of esketamine combined with dexmedetomidine anesthesia in pediatric laparoscopic surgery can alleviate stress reaction, promote the recovery and rehabilitation of children, reduce the dosage of ketamine, improve the restlessness of children during the recovery period, and will not increase the occurrence of adverse reactions.

Key words: esketamine, dextrmedetomidine, laparoscopic surgery, restlessness during awakening, stress reaction

中图分类号:

R726.1

杨强, 范超. 艾司氯胺酮复合右美托咪定麻醉对小儿腹腔镜手术应激反应和复苏质量的影响[J]. 中华养生保健, 2023, 41(11): 166-169.

YANG Qiang, FAN Chao. Effect of Esketamine Combined with Dextrmedetomidine Anesthesia on Stress Response and Resuscitation Quality in Children Undergoing Laparoscopic Surgery[J]. ZHONGHUA YANGSHENG BAOJIAN, 2023, 41(11): 166-169.

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