Tang Ling,Xiao Ting,Du Zhen,et al.Effectiveness and safety evaluations of s-ketamine during laparoscopic high ligation of hernia sac in children[J].Journal of Clinical Pediatric Surgery,2022,21(08):758-763.[doi:10.3760/cma.j.cn101785-202110038-010]
右旋氯胺酮用于小儿腹腔镜疝囊高位结扎术麻醉的有效性与安全性评价
- Title:
- Effectiveness and safety evaluations of s-ketamine during laparoscopic high ligation of hernia sac in children
- Keywords:
- Hernia; Inguinal/SU; Anesthesia/MT; Anesthetics/AD; Treatment Outcome; Anesthetics/AE; Child
- 摘要:
- 目的 对比右旋氯胺酮和舒芬太尼在小儿腹腔镜疝囊高位结扎术麻醉中的应用效果,探讨右旋氯胺酮和舒芬太尼用于小儿日间手术麻醉的有效性与安全性。方法 选择2020年3月至2020年8月在湖南省儿童医院拟行腹腔镜疝囊高位结扎术的80例患儿作为研究对象,采用随机数字表法分为右旋氯胺酮组(SK组,n=40)和舒芬太尼组(SF组,n=40)。两组麻醉诱导方法:SK组为右旋氯胺酮1.0 mg/kg静脉注射,SF组为舒芬太尼0.2 μg/kg静脉注射。观察两组患儿麻醉诱导前(T0)、诱导即刻(T1)、喉罩置入时(T2)、手术开始时(T3)、手术开始后5 min (T4)、手术结束时(T5)、离开手术室(T6)7个时点的血流动力学变化,术后自主呼吸恢复时间,麻醉苏醒时间,围手术期不良事件发生情况,以及术后躁动和疼痛评分情况。结果 SK组术后自主呼吸恢复时间为(4.2±1.8) min,麻醉苏醒时间为(24.2±4.5) min;SF组自主呼吸恢复时间为(5.1±1.9) min,麻醉苏醒时间为(29.3±7.3) min;SK组自主呼吸恢复时间和麻醉苏醒时间较SF组缩短,差异有统计学意义(P<0.05)。SK组术后30 min及术后1 h疼痛评分分别为0(0,0.75)、0(0,0.75),躁动评分分别为2(2,2)、2(2,2);SF组术后30 min及术后1 h疼痛评分分别为1(0,1)、2(0,4),躁动评分分别为2(2,2.75)、2(2,4);SK组术后30 min和术后1 h的疼痛评分及躁动评分均低于SF组,差异有统计学意义(P<0.05)。SK组麻醉诱导时发生呛咳1例(1/40,2.5%),SF组有7例(7/40,17.5%),差异有统计学意义(P<0.05)。两组不同时点血流动力学指标均稳定,差异无统计学意义(P>0.05)。结论 与舒芬太尼相比,右旋氯胺酮麻醉诱导具有较强的镇静、镇痛作用,患儿术后自主恢复更早,苏醒更快,不良事件发生率较低,可作为小儿腹腔镜疝囊高位结扎术较好的镇静镇痛药物选择。
- Abstract:
- Objective To compare the effects of dexketamine and sufentanil in the anesthesia of high ligation of laparoscopic hernia sac in children,and to explore the efficacy and safety of dexketamine and sufentanil in pediatric ambulatory surgery.Methods From March 2020 to August 2020,80 children who planned to have laparoscopic high ligation of hernia sac in Hunan Children’s Hospital were selected as the research objects.They were divided into dexketamine group (SK group,n=40) and sufentanil group (SF group,n=40) by random number table method.Anesthesia was induced by intravenous injection of dexketamine 1.0 mg/kg in SK group and sufentanil 0.2 μg/kg in SF group.The hemodynamic changes of the two groups were observed at 7 time points before anesthesia induction (T0),immediately after induction (T1),at the time of laryngeal mask insertion (T2),at the beginning of surgery (T3),5 min after surgery (T4),at the end of surgery (T5),leaving the operating room (T6),postoperative spontaneous breathing recovery time,anesthesia recovery time.Perioperative adverse events,and postoperative agitation and pain scores.Results The recovery time of spontaneous breathing and the recovery time of anesthesia in SK group were 4.2±1.8 min and 24.2±4.5 min,respectively.The recovery time of spontaneous breathing and the recovery time of anesthesia in SF group were 5.1±1.9 min and 29.3±7.3 min,respectively.The difference was statistically significant (P<0.05).In the SK group,the pain scores at 30 min and 1 h after operation were 0(0,0.75) and 0(0,0.75),and the agitation scores were 2(2,2) and 2(2,2),respectively.In SF group,the pain scores at 30 min and 1 h after operation were 1(0,1) and 2(0,4),and the agitation scores were 2(2,2.75) and 2(2,4),respectively.The pain score and agitation score at 30 min and 1 h after operation in SK group were lower than those in SF group,and the differences were statistically significant (P<0.05).Cough occurred in 1 case (1/40,2.5%) in SK group and 7 cases (7/40,17.5%) in SF group,and the difference was statistically significant (P<0.05).The hemodynamic indexes of the two groups were stable at different time points,and the difference was not statistically significant (P>0.05).Conclusion Compared with sufentanil,dexketamine anesthesia induction has stronger sedative and analgesic effects,with earlier postoperative spontaneous recovery,faster recovery,and lower incidence of adverse events.It can be used as a better sedative and analgesic drug choice for high ligation of laparoscopic hernia sac in children.
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备注/Memo
收稿日期:2021-10-27。
基金项目:2021年度湖南省卫生健康委科研立项课题(202104111245)
通讯作者:屈双权,Email:qushuangquan@126.com