首页|艾司氯胺酮复合右美托咪定用于小儿腹腔镜疝气手术的临床研究

艾司氯胺酮复合右美托咪定用于小儿腹腔镜疝气手术的临床研究

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目的 观察艾司氯胺酮注射液复合右美托咪定注射液联合骶管阻滞用于小儿腹腔镜疝气手术中的临床疗效及安全性.方法 将腹腔镜疝气术患儿随机分为对照组和试验组.2组患者均给予0.25%盐酸罗哌卡因+地塞米松进行骶管阻滞麻醉.对照组给予0.2-0.4μg·kg-1舒芬太尼+2.0 mg·kg-1丙泊酚+咪达唑仑2 mg+0.15 mg·kg-1顺式阿曲库铵进行麻醉诱导;然后给予静脉泵注0.10~0.25 μg·kg-1·min-1瑞芬太尼,复合吸入七氟醚0.8~1.5个肺泡最小有效浓度进行麻醉维持.试验组给予静脉注射0.5 mg·kg-1艾司氯胺酮+2.0 mg·kg-1丙泊酚+咪达唑仑2 mg+顺式阿曲库铵0.15 mg·kg-1进行麻醉诱导;然后给予持续静脉泵注0.3 μg·kg-1·h-1右美托咪定+0.25 mg·kg-1·h-1艾司氯胺酮,复合吸入七氟醚0.8~1.5个肺泡最小有效浓度进行麻醉维持.比较2组患儿的术后苏醒时间、拔管时间、麻醉室滞留时间,血清中C反应蛋白(CRP)、5-羟色胺和P物质水平,以及安全性.结果 试验组入组90例,脱落2例,最终有88例纳入统计分析;对照组入组90例,脱落3例,最终有87例纳入统计分析.试验组和对照组的术后苏醒时间分别为(8.27±2.90)和(14.09±3.61)min,拔管时间分别为(6.69±1.48)和(9.01±2.15)min,麻醉室滞留时间分别为(42.35±7.14)和(50.49±6.07)min,CRP水平分别为(8.92±1.76)和(10.46±2.07)mg·L-1,5-羟色胺水平分别为(34.61±7.29)和(42.19±7.81)ng·mL-1,P 物质水平分别为(63.05±12.07)和(75.91±13.27)ng·mL-1,在统计学上差异均有统计学意义(均P<0.05).2组患儿发生的药物不良反应均以嗜睡、术后呕吐、心动过缓为主.试验组和对照组的总药物不良反应发生率分别为12.50%和11.49%,在统计学上差异无统计学意义(P>0.05).结论 艾司氯胺酮注射液复合右美托咪定注射液用于小儿腹腔镜疝气手术中有助于缩短患儿术后恢复时间,减轻术后神经功能损伤风险,安全性较好.
Clinical trial of esketamine combined with dexmedetomidine in the treatment of pediatric laparoscopic hernia surgery
Objective To observe the clinical efficacy and safety of esketamine injection combined with dexmedetomidine injection combined with sacral block in pediatric laparoscopic hernia surgery.Methods The pediatric patients undergoing laparoscopic hernia repair were randomly divided into control group and treatment group.Both groups received caudal block anesthesia with 0.25%ropivacaine plus dexamethasone.In the control group,anesthesia induction was achieved with 0.2-0.4 μg·kg-1 sulfentanil,2.0 mg·kg-1 propofol,midazolam 2 mg,and 0.15 mg·kg-1 cisatracurium.Maintenance anesthesia was maintained with intravenous infusion of 0.10-0.25 μg·kg-1·min-1 remifentanil,combined with inhalation of 0.8-1.5 minimum alveolar concentration of sevoflurane.In the treatment group,anesthesia induction was conducted with 0.5 mg·kg-1 ketamine,2.0 mg·kg-1 propofol,midazolam 2 mg,and 0.15 mg·kg-1 cisatracurium.Maintenance anesthesia was maintained with continuous intravenous infusion of 0.3 μg·kg-1·h-1 dexmedetomidine plus 0.25 mg·kg-1·h-1 ketamine,combined with inhalation of 0.8-1.5 minimum alveolar concentration of sevoflurane.The surgical time,postoperative awakening time,extubation time,time spent in the anesthesia recovery room,serum levels of C-reactive protein(CRP),serotonin and P-substance,and safety were compared between the two groups.Results In the treatment group,90 cases were enrolled,2 cases dropout,and 88 cases were included in the statistical analysis.In the control group,90 cases were enrolled,3 cases dropout,and 87 cases were included in the statistical analysis.The postoperative recovery time of treatment and control groups was(8.27±2.90)and(14.09±3.61)min;the extubation time was(6.69±1.48)and(9.01±2.15)min;the anesthesia room retention time was(42.35±7.14)and(50.49±6.07)min;the levels of CRP were(8.92±1.76)and(10.46±2.07)mg·L-1;the levels of 5-hydroxytryptamine were(34.61±7.29)and(42.19±7.81)ng·mL-1;the levels of P-substance were(63.05±12.07)and(75.91±13.27)ng·mL-1,respectively.The differences of above indexes in two groups were statistically significant(all P<0.05).The adverse drug reactions of two groups were sedation,postoperative vomiting and bradycardia.The total incidences of adverse drug reactions in the treatment and control groups were 12.50%and 11.49%without significant difference(P>0.05).Conclusion The application of ketamine injection combined with dexmedetomidine injection in pediatric laparoscopic hernia surgery can help shorten the postoperative recovery time of children,reduce the risk of postoperative neurological damage,and have good safety.

esketamine injectiondexmedetomidine injectionherniapediatric anesthesiasafety evaluation

仇红霞、王灵芝

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南通市妇幼保健院麻醉科,江苏南通 226000

艾司氯胺酮注射液 右美托咪定注射液 疝气 小儿麻醉 安全性评价

2024

中国临床药理学杂志
中国药学会

中国临床药理学杂志

CSTPCD北大核心
影响因子:1.91
ISSN:1001-6821
年,卷(期):2024.40(22)