艾司氯胺酮与七氟烷对不插管全麻下儿童牙科治疗血流动力学及苏醒质量的影响  

Effects of esketamine and sevoflurane on hemodynamics and recovery quality in children undergoing dental treatment under non-intubated anesthesia

作　　者：吴波[1,2,3] 刘莉[1,2,3] 黄晨嘉 余伊[1,2,3] WU Bo;LIU Li;HUANG Chenjia;YU Yi(Department of Anesthesiology,the Affiliated Stomatological Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学附属口腔医院麻醉科,江苏南京210029 [2]南京医科大学口腔疾病研究江苏省重点实验室,江苏南京210029 [3]江苏省口腔转化医学工程研究中心,江苏南京210029

出　　处：《口腔医学》2023年第5期456-459,共4页Stomatology

基　　金：江苏省科教能力提升工程——江苏省研究型医院(YJXYYJSDW4),江苏省医学创新中心(CXZX202227)。

摘　　要：目的 分析艾司氯胺酮与七氟烷吸入方案对全麻下口腔日间手术儿童血流动力学及苏醒质量的影响。方法 选取我院2020年9月—2021年7月期间患有龋病的儿童136例,患儿因牙科恐惧症均拟实行全麻下日间牙科治疗,将其依照随机投掷法分为对照组、研究组。对照组给予艾司氯胺酮麻醉,研究组实施非插管下七氟烷吸入麻醉,对比两组手术相关情况、围术期各时刻MAP、HR、SpO_(2)指标、CHIPPS评分、PAED评分及麻醉相关不良反应事件发生率。结果 研究组麻醉起效时间及完全清醒时间均短于对照组(P<0.05);两组T_(1)时刻MAP、HR及SpO_(2)水平对比无较大差异(P>0.05);研究组T_(2)时刻MAP、HR低于对照组,差异明显(P<0.05);T_(1)、T_(2)、T_(3)各时刻SpO_(2)水平无较大差异(P>0.05);苏醒后15、30 min,研究组儿童CHIPPS评分及PAED评分与对照组相比更低,差异明显(P<0.05);不良反应方面,研究组总发生率2.90%(2/68),低于对照组的11.76%(8/68),差异明显(P<0.05)。结论 与艾司氯胺酮相比,七氟烷用于全麻下口腔日间手术儿童的价值及安全性更佳,麻醉起效快且苏醒质量好,同时有利于维持血流动力学稳定,降低呼吸抑制及呕吐等麻醉相关不良反应风险,更具推广价值。Objective To analyze the effects of esmketamine and sevoflurane inhalation regimens on hemodynamics and recovery quality in children undergoing oral day surgery under general anesthesia. Methods A total of 136 children with caries were selected from our hospital from September 2020 to July 2021. All patients were expected to receive daytime dental treatment under general anesthesia and divided into a control group and a study group according to the random throwing method. The control group was given esketamine anesthesia, and the study group was given non-intubation sevoflurane inhalation anesthesia. The operation-related conditions, MAP, HR, SpO_(2) indexes, CHIPPS score, PAED score and the incidence of anesthesia-related adverse events at each perioperative period were compared between the two groups. Results The onset time of anesthesia and the time of fully awake in the study group were shorter than those in the control group(P<0.05). There was no significant difference in the levels of MAP, HR and SpO_(2) at T_(1) between the two groups(P>0.05). MAP and HR were lower than those of the control group at T_(2), and the difference was significant(P<0.05). There was no significant difference in SpO_(2) levels at T_(1), T_(2), and T_(3)(P>0.05). The CHIPPS and PAED scores of the study group were significantly lower than those of the control group at 15 and 30 min after awakening. In terms of adverse reactions, the total incidence of adverse reactions in the study group was 2.90%(2/68), which was lower than 11.76%(8/68) in the control group, with a significant difference(P<0.05). Conclusion Compared with esmketamine, sevoflurane has better value and safety in children undergoing oral day surgery under general anesthesia. It has rapid onset of anesthesia and good recovery quality. At the same time, it is beneficial to maintain hemodynamic stability, reduce the risk of anesthesia-related adverse reactions such as respiratory depression and vomiting, and has more promotional value.

关 键 词：艾司氯胺酮 七氟烷 儿童全麻 牙科治疗 血流动力学 苏醒质量 

分 类 号：R614.2[医药卫生—麻醉学] R788.1[医药卫生—外科学]