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| 艾司氯胺酮复合右美托咪定滴鼻用于患儿疝囊高位结扎术前镇静的效果 |
| Efficacy of intranasal esketamine combined with dexmedetomidine for preoperative sedation in children undergoing aparoscopic high ligation of hernia sac |
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| DOI：10.12089/jca.2023.01.006 |
| 中文关键词: 镇静 艾司氯胺酮 右美托咪定 儿童 |
| 英文关键词: Sedation Esketamine Dexmedetomidine Child |
| 基金项目:淮安市自然科学研究计划（HAB201939，HAB202041） |
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| 中文摘要: |
目的 探讨艾司氯胺酮复合右美托咪定滴鼻用于患儿疝囊高位结扎术前镇静的安全性和有效性。
方法 选择择期行腹腔镜下疝囊高位结扎术的患儿87例，男82例，女5例，年龄1～3岁，体重9～18 kg，ASA Ⅰ或Ⅱ级。采用随机数字表法将患儿分为两组：右美托咪定组（D组，n=43）和艾司氯胺酮复合右美托咪定组（DS组，n=44）。D组采用右美托咪定2 μg/kg滴鼻，DS组采用右美托咪定2 μg/kg+艾司氯胺酮1 mg/kg滴鼻。记录滴鼻后30 min改良警觉/镇静（MOAA/S）量表评分、父母分离焦虑量表（PSAS）评分、面罩接受量表（MAS）评分。记录首次静脉穿刺成功率、镇静起效时间、补救镇静例数、术中芬太尼消耗量、苏醒时间、麻醉后监测治疗室（PACU）停留时间、术后补救镇痛例数及滴鼻后心动过缓、低血压、喉痉挛、低氧血症、术后躁动和术后呕吐的发生情况。
结果 与D组比较，DS组滴鼻后30 min MOAA/S评分、PSAS评分和MAS评分均明显降低，首次静脉穿刺成功率明显升高，镇静起效时间明显缩短，PACU停留时间明显缩短，补救镇痛率和心动过缓发生率明显降低（P<0.5）。两组术中芬太尼消耗量、苏醒时间差异无统计学意义。两组其余不良反应发生率差异无统计学意义。
结论 艾司氯胺酮复合右美托咪定滴鼻可安全有效地用于患儿疝囊高位结扎术前镇静，缩短镇静起效时间，提高首次静脉穿刺成功率且不增加不良反应。 |
| 英文摘要: |
Objective To evaluate the safety and efficacy of intranasal esketamine combined with dexmedetomidine for preoperative sedation in children undergoing aparoscopic high ligation of hernia sac.
Methods Eighty-seven children, 82 males and 5 females, aged 1-3 years, weighing 9-18 kg, ASA physical status Ⅰ or Ⅱ, undergoing aparoscopic high ligation of hernia sac were enrolled. Children were randomly allocated to receive intranasal dexmedetomidine 2 μg/kg (Group D, n = 43) or dexmedetomidine 2 μg/kg with esketamine 1 mg/kg (Group DS, n = 44). The modified observer's assessment of alertness/sedation scale (MOAA/S), parental separation anxiety scale (PSAS), mask acceptance scale (MAS) were recorded 30 minutes after administration. The successful rate of first venous cannulation and rescue sedation, the sedation onset time, the consumption of fentanyl, recovery time, the length of stay in PACU and the rate of rescue analgesia were recorded. The adverse effects such as bradycardia, hypotension, laryngospasm, hypoxemia, postoperative agitation, and postoperative vomiting were recorded.
Results Compared with group D, the MOAA/S score 30 minutes after premedication, PSAS score and MAS score were signifcantly lower in group DS, the sedation onset time in group DS was signifcantly shorter, and the successful rate of venous cannulation was signifcantly higher in group DS, the length of stay in PACU in group DS was signifcantly shorter, and the incidence of salvage analgesia in group DS was signifcantly lower, the incidence of bradycardia in the group DS was signifcantly lower (P < 0.05). There were no signifcances in fentanyl consumption and recovery time between the two groups. There were no significances in other adverse effects between the two groups.
Conclusion Combination of intranasal esketamine and dexmedetomidine can be used safely and effectively for preoperative sedation in children undergoing aparoscopic high ligation of hernia sac, shorten the sedation onset time, and increase the successful rate of the first venous cannulation without increasing the occurrence of adverse reactions. |
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