七氟醚复合低剂量艾司氯胺酮麻醉在小儿烧伤扩创削痂生物敷料覆盖手术中的应用  

Application of Sevoflurane Combined with Low Dose Esketamine Anesthesia in Biological Dressing Covering Operation for Pediatric Burn Wound

作　　者：同鑫 魏莹[2] 谢江帆 TONG Xin;WEI Ying;XIE Jiangfan(Department of Anesthesia,Zhengzhou First People’s Hospital,Zhengzhou 450000,China;the First Department of Burns,Zhengzhou First People’s Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州市第一人民医院麻醉科,河南郑州450000 [2]郑州市第一人民医院烧一科,河南郑州450000

出　　处：《河南医学研究》2023年第21期3885-3889,共5页Henan Medical Research

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20210714)。

摘　　要：目的探讨七氟醚复合低剂量艾司氯胺酮麻醉在小儿烧伤扩创削痂生物敷料覆盖手术中的应用效果。方法选取2019年1月至2022年1月在郑州市第一人民医院行扩创削痂生物敷料覆盖手术治疗的126例烧伤患儿,采用随机数字表法分为观察组(63例)和对照组(63例),两组患儿均静脉注射咪达唑仑0.1~0.2 mg·kg^(-1)、舒芬太尼0.1~0.2μg·kg^(-1),罗库溴铵0.8 mg·kg^(-1)、丙泊酚2 mg·kg^(-1)进行麻醉诱导,对照组接受七氟醚进行麻醉维持,观察组接受七氟醚复合低剂量艾司氯胺酮进行麻醉维持。比较两组患儿苏醒即刻、苏醒后10 min、苏醒后30 min的疼痛评分以及苏醒时间、出室时Ramsay镇静评分;分别于麻醉诱导前(T_(0))、麻醉诱导后5 min(T_(1))、削痂时(T_(2))、敷料时(T_(3))、手术结束时(T_(4))记录两组患儿的平均动脉压(MAP)、心率(HR)、呼吸(RR);比较两组患儿不良反应发生率。结果两组苏醒后10、30 min疼痛评分均高于苏醒即刻(P<0.05),两组苏醒后30 min疼痛评分高于苏醒后10 min(P<0.05),观察组苏醒后10、30 min疼痛评分低于对照组(P<0.05)。观察组术后苏醒时间短于对照组(P<0.05),出室时Ramsay镇静评分高于对照组(P<0.05);两组T_(1)、T_(2)、T_(3)时HR均低于T_(0),T_(4)时均高于T_(1)、T_(2)、T_(3),对照组T_(4)时HR低于T_(0)(P<0.05);观察组T_(1)、T_(2)、T_(3)时MAP均低于T_(0),T_(4)时高于T_(1)(P<0.05),对照组T_(1)、T_(2)、T_(3)、T_(4)时MAP均低于T_(0),T_(2)、T_(3)、T_(4)时均高于T_(1),T_(4)时高于T_(2)、T_(3)(P<0.05),且观察组T_(1)、T_(2)、T_(3)时HR、MAP均高于对照组(P<0.05);观察组患儿术后不良反应发生率低于对照组(P<0.05)。结论七氟醚复合低剂量艾司氯胺酮麻醉可有效稳定烧伤患儿扩创削痂生物敷料覆盖手术中的血流动力学,且有较好的镇痛镇静效果,安全性高。Objective To explore the application effect of sevoflurane combined with low-dose esketamine anesthesia in pediatric burn wound eschar shaving biological dressing covering operation.Methods A total of 126 children with burns who underwent debridement and eschar shaving biological dressing covering surgery in Zhengzhou First People’s Hospital from January 2019 to January 2022 were selected,and they were divided into observation group(63 cases)and control group(63 cases)by random number table method.Both groups were given intravenous injection of midazolam 0.1-0.2 mg·kg^(-1),sufentanil 0.1-0.2μg·kg^(-1),rocuronium 0.8 mg·kg^(-1)and propofol 2 mg·kg^(-1)for anesthesia induction,while the control group was maintained with sevoflurane anesthesia,but the observation group was treated with sevoflurane combined with low-dose esketamine for anesthesia maintenance.The children pain scores of immediately awakening,10 minutes after awakening,30 minutes after awakening,recovery time and Ramsay sedation score were compared between the two groups.The mean arterial pressure(MAP),heart rate(HR)and respiratory rate(RR)of the two groups were recorded before anesthesia induction(T_(0)),5 minutes after anesthesia induction(T_(1)),during eschar shaving(T_(2)),during dressing(T_(3))and at the end of operation(T_(4)).The incidence of adverse reactions was compared between the two groups.Results The difference of pain scores was statistically significant by repeated measurement analysis of variance(P<0.05).The pain scores of the two groups at 10 minutes and 30 minutes after recovery were higher than those immediately after recovery(P<0.05).The pain scores of the two groups at 30 minutes after recovery were higher than those at 10 minutes after recovery(P<0.05).The pain scores of the observation group at 10 minutes and 30 minutes after recovery were lower than those of the control group(P<0.05).The postoperative recovery time of the observation group was lower than that of the control group(P<0.05),and the Ramsay sedation score was

关 键 词：七氟醚 艾司氯胺酮 烧伤 扩创削痂 生物敷料覆盖 

分 类 号：R614[医药卫生—麻醉学]