艾司氯胺酮复合不同剂量瑞马唑仑用于患儿麻醉诱导的效果  

Efficacy of esketamine combined with different doses of remimazolam for induction of general anesthesia in pediatric patients

作　　者：姬乐婷[1] 杜宁宁 丁宁 董正华[1] 刘博[1] 李长生 Ji Leting;Du Ningning;Ding Ning;Dong Zhenghua;Liu Bo;Li Changsheng(Department of Anesthesiology,The Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院麻醉科,郑州450052

出　　处：《中华麻醉学杂志》2024年第3期349-352,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价艾司氯胺酮复合不同剂量瑞马唑仑用于患儿麻醉诱导的效果。方法择期行喉罩全身麻醉患儿160例,年龄3~6岁,性别不限,ASA分级Ⅰ或Ⅱ级,体质量指数13~20 kg/m2,采用随机数字表法将患儿分为4组(n=40):艾司氯胺酮复合丙泊酚组(KP组)和艾司氯胺酮复合不同剂量瑞马唑仑(0.2、0.3、0.4 mg/kg)组(KR1组、KR2组和KR3组)。患儿在预麻间静脉注射艾司氯胺酮0.8 mg/kg。入手术室后KP组静脉注射丙泊酚2.5 mg/kg,KR1组、KR2组和KR3组分别静脉注射瑞马唑仑0.2、0.3和0.4 mg/kg,待患儿意识消失,改良警觉镇静评分(MOAA/S评分)<1分时,静脉注射舒芬太尼和米库氯铵。MOAA/S评分≥1分时进行补救镇静,3 min后置入喉罩。记录镇静起效时间,以及喉罩置入反应、补救镇静、低血压、心动过速、心动过缓、呛咳、呃逆、注射痛和呼吸暂停的发生情况,计算灌注指数(PI)增加率。结果4组患儿均未发生喉罩置入反应。与KP组比较,KR1组、KR2组和KR3组镇静起效时间延长,低血压、心动过缓、注射痛和呼吸暂停发生率降低,心动过速发生率升高,PI增加率降低,KR1组和KR2组补救镇静率和呛咳发生率升高(P<0.05);与KR1组比较,KR2组和KR3组起效时间缩短,KR3组补救镇静率和呛咳发生率降低(P<0.05);与KR2组比较,KR3组起效时间缩短,补救镇静率降低(P<0.05)。KR1组、KR2组和KR3组PI增加率、低血压、心动过缓、心动过速、注射痛和呼吸暂停发生率比较差异无统计学意义(P>0.05)。4组呃逆发生率比较差异无统计学意义(P>0.05)。结论艾司氯胺酮0.8 mg/kg复合瑞马唑仑0.4 mg/kg可安全有效地用于患儿麻醉诱导,对呼吸、循环抑制作用较艾司氯胺酮复合丙泊酚减轻。Objective To evaluate the efficacy of esketamine combined with different doses of remimazolam for induction of general anesthesia in pediatric patients.Methods One hundred and sixty pediatric patients of either sex,aged 3-6 yr,of American Society of Anesthesiologists Physical Status classificationⅠorⅡ,with body mass index of 13-20 kg/m2,undergoing elective general anesthesia under a laryngeal mask,were divided into 4 groups(n=40 each)by the random number table method:esketamine combined with propofol group(KP group)and esketamine combined with different doses of remimazolam group(0.2,0.3,0.4 mg/kg)groups(KR1 group,KR2 group,KR3 group).Esketamine 0.8 mg/kg was intravenously injected in the preanesthesia room.After entering the operating room,propofol 2.5 mg/kg was intravenously injected in KP group,and remimazolam 0.2,0.3 and 0.4 mg/kg were intravenously injected in KR1,KR2 and KR3 groups,respectively.When the child lost consciousness and the Modified Observer′s Assessment of Alertness/Sedation Scale score<1,sufentanil and mevacurium were intravenously injected.When the Modified Observer′s Assessment of Alertness/Sedation Scale score≥1,rescue sedation was performed,and 3 min later the laryngeal mask airway was inserted.The onset time of sedation,response to laryngeal mask airway placement,rescue sedation,hypotension,tachycardia,bradycardia,bucking,hiccup,injection pain and apnea were recorded,and the increase rate of perfusion index(PI)was calculated.Results No response to laryngeal mask implantation occurred in the four groups.Compared with KP group,the onset time of sedation was significantly prolonged,the incidence of hypotension,bradycardia,injection pain and apnea was decreased,the incidence of tachycardia was increased,and the increase rate of PI was decreased in KR1,KR2 and KR3 groups,and the rate of rescue sedation and incidence of bucking were increased in KR1 and KR2 groups(P<0.05).Compared with KR1 group,the onset time of sedation was significantly shortened in KR2 group and KR3 group,and the

关 键 词：苯二氮䓬类 儿童 艾司氯胺酮 麻醉诱导 

分 类 号：R726.1[医药卫生—儿科]