南方医科大学学报

南方医科大学学报 ›› 2022, Vol. 42 ›› Issue (10): 1584-1586.doi: 10.12122/j.issn.1673-4254.2022.10.21

• • 上一篇    

小剂量艾司氯胺酮在小儿外科全麻术中的应用

陈启忠，廖艺聪，李志勤   

  1. 厦门大学附属妇女儿童医院（厦门市妇幼保健院）麻醉科，福建 厦门 361000；厦门大学附属翔安医院麻醉科，福建 厦门 361005
  • 出版日期:2022-10-20 发布日期:2022-10-31

Application of low-dose esmolamine in general anesthesia in pediatric surgeries

CHEN Qizhong, LIAO Yicong, LI Zhiqin   

  1. Department of Anesthesiology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen 361000, China; Department of Anesthesiology, Xiang'an Hospital of Xiamen University, Xiamen 361005, China
  • Online:2022-10-20 Published:2022-10-31

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摘要： 目的 探讨术中持续小剂量输注艾司氯胺酮对小儿全麻术术中阿片类药物使用量和患者苏醒质量的影响。方法 选取100例全身麻醉下小儿外科手术患者，按照随机数表法分为A组（观察组）、B组（对照组），50例/组；A组于全身麻醉诱导前10 min静脉注射0.1 mg/kg艾司氯胺酮，后静脉泵注艾司氯胺酮 2 μg/ （kg·min）至术毕；B组同时泵注等容量生理盐水。记录术中瑞芬太尼使用量；记录所有患者自主呼吸恢复时间、苏醒时间和拔管时间；记录患者拔管后15、30、60 min时VAS评分，若VAS评分≥4分，静脉注射纳布啡0.3 mg/kg，可重复使用，并记录纳布啡总用量；记录所有患者不良事件发生情况。结果 A组术中使用瑞芬太尼量总量低于B组（P<0.05）；两组患者自主呼吸恢复时间、苏醒时间和拔管时间无统计学意义；A组患者拔管后15、30、60 min时VAS评分优于B组（P<0.05），且A组使用纳布啡总剂量低于B组（P<0.05）。结论 在小儿外科手术术中持续输注小剂量艾司氯胺酮，可有效降低术中阿片类药物使用量，降低苏醒期疼痛程度，且不影响患者苏醒质量。

关键词: 艾司氯胺酮；瑞芬太尼；少阿片麻醉；小剂量

Abstract: Objective To explore the effect of continuous low-dose infusion of esmolamine on intraoperative dosage of opioids and awakening quality in general anesthesia in pediatric surgeries. Methods A total of 100 children (6-8 years of age) undergoing pediatric surgery under general anesthesia were randomized equally into observation group and control group. In the observation group, the children received an intravenous injection of 0.1mg/kg esmolamine 10 min before induction of general anesthesia, followed by intravenous infusion of esmolamine at 2 μg · kg-1 · min-1 until the end of the operation; those in the control group were infused with the same volume of normal saline instead of esmolamine in the same manner. The dosage of remifentanil during operation, recovery time of spontaneous breathing, recovery time of consciousness and extubation time were recorded in all the cases. The VAS score at 15, 30 and 60 min after extubation were assessed, and intravenous injection of naborphine 0.3 mg/kg was given for a VAS score ≥4; the total dosage of naborphine and adverse events were recorded for all the patients. Results The total dose of remifentanil was significantly lower in the observation group than in the control group, but the spontaneous respiratory recovery time, consciousness recovery time and extubation time did not differ significantly between the two groups. The VAS scores at 15, 30 and 60 min after extubation were all better in the observation group than in the control group; the total intraoperative dose of naborphine was significantly lower in the observation group. Conclusion Continuous infusion of low-dose esmolamine during pediatric surgery can effectively lower intraoperative dosage of opioids and reduce pain during recovery without affecting the quality of awakening.

Key words: esketamine; remifentanil; opioid-reduced anesthesia; low dose