小剂量艾司氯胺酮复合异丙酚静脉麻醉在小儿无痛肠镜的临床应用  

Clinical study on intravenous anesthesia with low-dose esketamine combined with propofol in painless colonoscopy for children

作　　者：丁松 张浩[2] 晏明 张玉凤 齐敦益 DING Song;ZHANG Hao;YAN Ming;ZHANG Yufeng;QI Dunyi(Xuzhou Medical University,Xuzhou 221000,Jiangsu,China;Department of Anesthesiology,Huai’an Maternal and Child Health Hospital,Huai’an 223001,Jiangsu,China;Department of Anesthesiology,The Affiliated Hospital of Xuzhou Medical University,Xuzhou 221004,Jiangsu,China)

机构地区：[1]徐州医科大学,江苏徐州221000 [2]淮安市妇幼保健院麻醉科,江苏淮安223001 [3]徐州医科大学附属医院麻醉科,江苏徐州221004

出　　处：《西部医学》2023年第10期1519-1523,共5页Medical Journal of West China

基　　金：淮安市科技项目(HAB201939)。

摘　　要：目的探讨小剂量艾司氯胺酮复合异丙酚静脉麻醉在小儿无痛肠镜的临床应用效果。方法选取2020年9月—2022年5月在淮安市妇幼保健院行无痛肠镜的112例患儿作为研究对象,按照随机数字表法分为A组(37例)、B组(38例)、C组(37例)。A组患儿予0.3 mg/kg艾司氯胺酮+2.0 mg/kg异丙酚静脉麻醉,B组予0.2μg舒芬太尼+2.0 mg/kg异丙酚静脉麻醉,C组予2.0 mg/kg异丙酚静脉麻醉,并推注与A组艾司氯胺酮同等体积生理盐水,对比3组患儿首剂量麻醉成功率、检查操作时间、麻醉苏醒时间、疼痛及苏醒期躁动情况以及疼痛应激反应,随访24 h,统计3组患儿随访期间麻醉后不良反应发生情况。结果A组患儿首剂量麻醉成功率高于B组、C组(P<0.05),肠镜检查操作时间及苏醒时间短于B组、C组(P<0.05)。3组患儿麻醉5 min后(T_(1))改良面部表情疼痛评分法(FLACC)对比,差异无统计学意义(P>0.05),麻醉15 min(T_(2))及25 min(T_(3))后,A组FLACC评分均低于B组、C组(P<0.05);检查结束后10 min(T_(4))及20 min(T_(5))时,A组苏醒期躁动评分量表(PAED)评分均低于B组、C组(P<0.05),3组患儿检查结束后30 min(T_(6))时PAED评分对比,差异无统计学意义(P>0.05)。3组患儿给药前(T_(7))心率(HR)及血氧饱和度(SPO_(2))对比,差异无统计学意义(P>0.05);肠镜经过肝曲(T_(8))、肠镜经过脾曲(T_(9))及检查结束时(T_(10)),A组HR水平高于B组、C组(P<0.05),3组SPO_(2)水平对比,差异无统计学意义(P>0.05);3组患儿T_(7)时MAP下降比例对比,差异无无统计学意义(P>0.05);T_(8)、T_(9)及T_(10)时,A组患儿MAP下降比例低于B组、C组(P<0.05)。3组麻醉后不良反应对比,差异无统计学意义(P>0.05)。结论小剂量艾司氯胺酮复合异丙酚在小儿肠镜检查中麻醉效果确切,能够缩短检查操作时间,减轻患儿疼痛及应激反应,促进患儿尽早苏醒,且具有一定的安全性。Objective To observe the clinical application effects of intravenous anesthesia with low-dose esketamine combined with propofol on painless colonoscopy for children.Methods 112 children who underwent painless colonoscopy in Huai’an Maternal and Child Health Hospital from September 2020 to May 2022 were selected as the research subjects,and were divided into group A(n=37),group B(n=38)and group C(n=37)according to the random number table method.The children in group A adopted intravenous anesthesia with 0.3 mg/kg of esketamine combined with 2.0 mg/kg of propofol,the children in group B received 0.2μg of sufentanil+2.0 mg/kg of propofol for intravenous anesthesia,and the children in group C were given intravenous anesthesia with 2.0 mg/kg of propofol alone and then injected with the same volume of normal saline as esketamine in group A.The success rate of first-dose anesthesia,operation time,anesthesia awakening time,pain and emergence agitation and pain stress response were compared between the two groups.After 24 h of follow-up,the occurrence of adverse reactions after anesthesia in the three groups were statistically analyzed during follow-up.Results The success rate of first-dose anesthesia in group A was higher than that ingroup B and group C,and the colonoscopy operation time and awakening time were shorter than those in group B and group C(P<0.05).There was no statistical significance in the score of Faces,Legs,Activity,Cry and Consolability(FLACC)among the three groups after 5 min of anesthesia(T_(1))(P>0.05).After 15 min(T_(2))and 25 min(T_(3))of anesthesia,the FLACC scores were lower in group A than those in groups B and C(P<0.05).The scores of Pediatric Anesthesia Emergence Delirium Scale(PAED)in group A at 10 min(T_(4))and 20 min(T_(5))after the end of the examination were lower than those in groups B and C(P<0.05),and there was no statistical difference in the PAED score at 30 min(T_(6))after the end of the examination among the three groups(P>0.05).There were no statistical differences in heart rat

关 键 词：无痛肠镜 艾司氯胺酮 异丙酚 小儿 麻醉效果 

分 类 号：R574[医药卫生—消化系统]