南方医科大学学报

南方医科大学学报 ›› 2023, Vol. 43 ›› Issue (12): 2126-2131.doi: 10.12122/j.issn.1673-4254.2023.12.18

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瑞马唑仑与艾司氯胺酮用于小儿术前镇静的临床效果与安全性对比

吴美潮，杨芳芳，马行军，蔡 宁   

  1. 阜阳市人民医院麻醉科，安徽 阜阳 236000
  • 出版日期:2023-12-20 发布日期:2023-12-29

Comparison of clinical effects and safety of remidazolam and esketamine for preoperative sedation in children

WU Meichao, YANG Fangfang, MA Xingjun, CAI Ning   

  1. Department of Anesthesia, Fuyang People's Hospital, Fuyang 236000, China
  • Online:2023-12-20 Published:2023-12-29

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摘要： 目的 通过对比瑞马唑仑与艾司氯胺酮用于小儿术前镇静的临床效果，明确瑞马唑仑用于小儿术前镇静的有效性及安全性。方法 选择2022年1月~2023年3月择期全麻下行双侧扁桃体和（或）腺样体切除手术的1~4岁患儿61例随机分为两组，其中瑞马唑仑组（R组）30例，艾司氯胺酮组（S组）31例。R组静脉应用瑞马唑仑0.2 mg/kg进行术前镇静，S组静脉应用艾司氯胺酮0.5 mg/kg进行术前镇静。记录两组患儿镇静后PSAS评分，生命体征（MAP、SpO2、HR），镇静评分，诱导时面罩接受程度评分，镇静起效时间、术后苏醒时间，诱导后MAP、HR，苏醒后Ramsay镇静评分，麻醉期间丙泊酚、瑞芬太尼用量，麻醉苏醒期躁动（EA），术后不良反应（呼吸抑制、恶心、呕吐）及术后第7天、第14天术后不良行为改变（NPOBCs）发生。结果 两组患儿镇静后PSAS评分，镇静评分，诱导时面罩接受程度评分，诱导后MAP、HR，苏醒后Ramsay镇静评分，麻醉诱导丙泊酚用量，麻醉苏醒期躁动发生率，及术后第7 d、第14 d术后不良行为改变发生率对比，差异无统计学意义（P>0.05）。与S组对比，R组镇静起效时间略长，麻醉苏醒时间短，麻醉维持丙泊酚及瑞芬太尼用量多（P<0.05）。与镇静前对比，R组镇静后MAP、SpO2、HR变化不大，差异无统计学意义（P>0.05）；S组镇静后MAP、HR升高，差异有统计学意义（P<0.05），而SpO2变化不大，差异无统计学意义（P>0.05）。结论 与0.5 mg/kg艾司氯胺酮相比，静脉注射0.2 mg/kg瑞马唑仑用于1~4岁小儿术前镇静起效时间略长，苏醒时间短，血流动力学更平稳，具有可行性及安全性。

关键词: 瑞马唑仑；艾司氯胺酮；儿童；术前镇静

Abstract: Objective To compare the clinical effects and safety of remiazolam and esketamine in preoperative sedation in children. Methods This study was conducted among 61 children (1-4 years old) undergoing elective bilateral tonsillectomy with or without adenoidectomy under general anesthesia from January 2022 to March 2023. The children were randomized into two groups to receive preoperative sedation with intravenous administration of 0.2 mg/kg remidazolam (R group, 30 cases) or 0.5 mg/kg esketamine (S group, 31 cases). The two groups were compared for PSAS score, vital signs (MAP, SpO2, and HR), sedation score, mask acceptance score at induction, sedation onset time, postoperative recovery time, MAP and HR after induction, Ramsay sedation score after awakening, doses of propofol and remifentanil during anesthesia, emergence agitation (EA), postoperative adverse effects and negative postoperative behavioral changes (NPOBCs) on the 7th and 14th days after operation. Results The PSAS score, sedation score, mask acceptance score at induction, MAP and HR after induction, Ramsay sedation score after awakening, propofol dose during anesthesia induction, and the incidence of EA and NPOBCs after operation were all similar between the two groups (P>0.05). Compared with those in S group, the sedation onset time was slightly longer, the recovery time was shorter, and the doses of propofol and remifentanil for anesthesia maintenance was higher (P<0.05) in R group. Sedation with remidazolam did not cause significant changes in MAP, SpO2 or HR (P>0.05), while administration of esketamine significantly increased MAP and HR (P<0.05) without obviously affecting SpO2 (P>0.05). Conclusion In children aged 1-4 years, compared with 0.5 mg/kg esketamine, intravenous injection of 0.2 mg/kg remidazolam for preoperative sedation has a slightly longer onset time and is associated with a shorter recovery time and more stable hemodynamics, suggesting its good feasibility and safety.

Key words: remidazolam; esketamine; children; preoperative sedation