临床误诊误治2024，Vol.37Issue(14) ：64-69.DOI:10.3969/j.issn.1002-3429.2024.14.014

艾司氯胺酮辅助臂丛神经阻滞麻醉对小儿上肢骨折手术血流动力学、OAA/S评分和应激损伤的影响

Effects of Esketamine-assisted Brachial Plexus Block Anesthesia on Hemo-dynamics,OAA/S Score and Stress Injury in Children Undergoing Surgery for Upper Limb Fractures

张瑜 马伟 李蕾 高岩
临床误诊误治2024，Vol.37Issue(14) ：64-69.DOI:10.3969/j.issn.1002-3429.2024.14.014
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艾司氯胺酮辅助臂丛神经阻滞麻醉对小儿上肢骨折手术血流动力学、OAA/S评分和应激损伤的影响

Effects of Esketamine-assisted Brachial Plexus Block Anesthesia on Hemo-dynamics,OAA/S Score and Stress Injury in Children Undergoing Surgery for Upper Limb Fractures

张瑜 1马伟 2李蕾 1高岩1
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作者信息

  • 1. 063000 河北唐山,唐山市妇幼保健院麻醉科
  • 2. 063000 河北唐山,华北理工大学附属医院麻醉科
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摘要

目的 探讨艾司氯胺酮辅助臂丛神经阻滞麻醉对小儿上肢骨折手术血流动力学、警觉/镇静观察(OAA/S)评分和应激损伤的影响.方法 选取 2021 年 10 月至 2023 年 10 月收治的 120 例行小儿上肢骨折手术患儿,采用随机数表法分为喉罩全身麻醉组和艾司氯胺酮组各60 例,喉罩全身麻醉组采用喉罩全身麻醉辅助臂丛神经阻滞麻醉,艾司氯胺酮组采用艾司氯胺酮辅助臂丛神经阻滞麻醉,2 组臂丛神经阻滞麻醉、麻醉诱导、麻醉维持均相同.比较2 组麻醉相关指标[手术时间、麻醉后恢复室(PACU)停留时间、术后苏醒时间、疼痛行为评估量表评分],比较麻醉前(T0)、切皮时(T1)、手术 30 min(T2)、手术结束时(T3)、苏醒时(T4)平均动脉压(MAP)、心率(HR)变化,T0、T1、T2 和T3 时OAA/S评分、脑电双频指数(BIS)变化,术前、术后 1d应激损伤指标[皮质醇(Cor)、肾上腺素(E)、去甲肾上腺素(NE)和血糖]水平,并记录2 组麻醉不良反应.结果 艾司氯胺酮组PACU停留时间、术后苏醒时间均短于喉罩全身麻醉组(P＜0.01).T0～T4 时2 组患儿MAP、HR均呈先升高后降低趋势,且T1、T2 和T3 时艾司氯胺酮组均高于喉罩全身麻醉组(P＜0.05),T0、T4 时比较差异无统计学意义(P＞0.05).T0～T3 时 2 组患儿OAA/S评分、BIS值均呈先降低后升高趋势,且T1、T2 时艾司氯胺酮组均略高于喉罩全身麻醉组,但组间比较差异无统计学意义(P＞0.05).T0、T3 时2 组OAA/S评分、BIS值比较差异无统计学意义(P＞0.05).术后 1d,2 组患儿Cor、E、NE、血糖均比术前升高(P＜0.05),但2 组间比较差异无统计学意义(P＞0.05).2 组麻醉不良反应比较差异无统计学意义(P＞0.05).结论 艾司氯胺酮辅助臂丛神经阻滞麻醉镇静效果较良好,可以缩短患儿术后苏醒时间,但喉罩全身麻醉辅助臂丛神经阻滞麻醉在术中维持血流动力学水平上更具优势,且二者均不会增加术后应激损伤和不良反应.

Abstract

Objective To investigate the effects of Esketamine-assisted brachial plexus block anesthesia on hemody-namics,observer's assessment of alertness/sedation(OAA/S)score and stress injury in children undergoing surgery for upper limb fractures.Methods A total of 120 children undergoing surgery for upper limb fractures from October 2021 to October 2023 were selected and divided into laryngeal mask general anesthesia group(n=60)and Esketamine group(n=60)by ran-dom number table method.Laryngeal mask general anesthesia-assisted brachial plexus block anesthesia was given in the laryn-geal mask general anesthesia group,while Esketamine-assisted brachial plexus block anesthesia was given in Esketamine group.Brachial plexus block anesthesia,anesthesia induction and anesthesia maintenance were the same in the two groups.Anesthesia-related indexes[duration of operation,length of postanesthesia care unit(PACU)stay,postoperative recovery time,Behavioral Pain Assessment Scale score]were compared between the two groups.The changes of mean arterial pressure(MAP)and heart rate(HR)before anesthesia(T0),at incision(T1),at 30 min after surgery(T2),at the end of surgery(T3),and at the time of recovery(T4),as well as OAA/S score and bispectral(BIS)index at T0,T1,T2 and T3 were compared.The levels of stress injury indexes[cortisol(Cor),epinephrine(E),norepinephrine(NE)and blood glucose]before and at 1 d after surgery,and the adverse reactions of anesthesia in the two groups were recorded.Results Length of PACU stay and postoperative recovery time in Esketamine group were shorter than those in laryngeal mask anesthesia group(P＜0.01).MAP and HR in the two groups increased first and then decreased at T0-T4,which were higher in Esketamine group than in laryngeal mask general anesthesia group at T1,T2 and T3(P＜0.05),but there was no statistical significance at T0 and T4(P＞0.05).OAA/S scores and BIS values in the two groups decreased first and then increased at T0-T3,which were slightly higher in Esketamine group than in laryngeal mask general anesthesia group at T1 and T2,but there was no sta-tistical significance between groups(P＞0.05).There was no significant difference in OAA/S score and BIS value at T0 and T3 between the two groups(P＞0.05).At 1 d after surgery,Cor,E,NE and blood glucose in the two groups were higher than those before surgery(P＜0.05),but there was no statistical significance between the two groups(P＞0.05).There was no significant difference in adverse reactions to anesthesia between the two groups(P＞0.05).Conclusion Esketamine-assisted brachial plexus block anesthesia has better sedation effect and can shorten the postoperative recovery time of children,but laryngeal mask general anesthesia-assisted brachial plexus block anesthesia has more advantages in maintaining the hemo-dynamic level during the operation,and neither of them will increase the postoperative stress injury and adverse reactions.

关键词

上肢手术/儿童/麻醉/艾司氯胺酮/血流动力学/警觉/镇静观察评分/应激损伤

Key words

Upper limb surgery/Children/Anesthesia/Esketamine/Hemodynamics/Observer's assessment of alert-ness/sedation/Stress injury

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基金项目

河北省医学科学研究重点课题计划项目(20240471)

出版年

2024
临床误诊误治
解放军白求恩国际和平医院

临床误诊误治

CSTPCD
影响因子：0.914
ISSN：1002-3429
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