艾司氯胺酮辅助臂丛神经阻滞麻醉对小儿上肢骨折手术血流动力学、OAA/S评分和应激损伤的影响  

Effects of Esketamine⁃assisted Brachial Plexus Block Anesthesia on Hemo⁃dynamics,OAA/S Score and Stress Injury in Children Undergoing Surgery for Upper Limb Fractures

作　　者：张瑜 马伟 李蕾 高岩 ZHANG Yu;MA Wei;LI Lei;GAO Yan(Department of Anesthesiology,Tangshan Maternal and Child Health Hospital,Tangshan,Hebei 063000,China;De-partment of Anesthesiology,the Affiliated Hospital of North China University of Science and Technology,Tangshan,Hebei)

机构地区：[1]唐山市妇幼保健院麻醉科,河北唐山063000 [2]华北理工大学附属医院麻醉科,河北唐山063000

出　　处：《临床误诊误治》2024年第14期64-69,共6页Clinical Misdiagnosis & Mistherapy

基　　金：河北省医学科学研究重点课题计划项目(20240471)。

摘　　要：目的探讨艾司氯胺酮辅助臂丛神经阻滞麻醉对小儿上肢骨折手术血流动力学、警觉/镇静观察(OAA/S)评分和应激损伤的影响。方法选取2021年10月至2023年10月收治的120例行小儿上肢骨折手术患儿,采用随机数表法分为喉罩全身麻醉组和艾司氯胺酮组各60例,喉罩全身麻醉组采用喉罩全身麻醉辅助臂丛神经阻滞麻醉,艾司氯胺酮组采用艾司氯胺酮辅助臂丛神经阻滞麻醉,2组臂丛神经阻滞麻醉、麻醉诱导、麻醉维持均相同。比较2组麻醉相关指标[手术时间、麻醉后恢复室(PACU)停留时间、术后苏醒时间、疼痛行为评估量表评分],比较麻醉前(T0)、切皮时(T1)、手术30 min(T2)、手术结束时(T3)、苏醒时(T4)平均动脉压(MAP)、心率(HR)变化,T0、T1、T2和T3时OAA/S评分、脑电双频指数(BIS)变化,术前、术后1 d应激损伤指标[皮质醇(Cor)、肾上腺素(E)、去甲肾上腺素(NE)和血糖]水平,并记录2组麻醉不良反应。结果艾司氯胺酮组PACU停留时间、术后苏醒时间均短于喉罩全身麻醉组(P<001)。T0~T4时2组患儿MAP、HR均呈先升高后降低趋势,且T1、T2和T3时艾司氯胺酮组均高于喉罩全身麻醉组(P<0.05),T0、T4时比较差异无统计学意义(P>0.05)。T0~T3时2组患儿OAA/S评分、BIS值均呈先降低后升高趋势,且T1、T2时艾司氯胺酮组均略高于喉罩全身麻醉组,但组间比较差异无统计学意义(P>0.05)。T0、T3时2组OAA/S评分、BIS值比较差异无统计学意义(P>0.05)。术后1 d,2组患儿Cor、E、NE、血糖均比术前升高(P<0.05),但2组间比较差异无统计学意义(P>0.05)。2组麻醉不良反应比较差异无统计学意义(P>0.05)。结论艾司氯胺酮辅助臂丛神经阻滞麻醉镇静效果较良好,可以缩短患儿术后苏醒时间,但喉罩全身麻醉辅助臂丛神经阻滞麻醉在术中维持血流动力学水平上更具优势,且二者均不会增加术后应激损伤和不良反应。Objective To investigate the effects of Esketamine-assisted brachial plexus block anesthesia on hemody-namics,observer's assessment of alertness/sedation(OAA/S)score and stress injury in children undergoing surgery for upper limb fractures.Methods A total of 120 children undergoing surgery for upper limb fractures from October 2021 to October 2023 were selected and divided into laryngeal mask general anesthesia group(n=60)and Esketamine group(n=60)by ran-dom number table method.Laryngeal mask general anesthesia-assisted brachial plexus block anesthesia was given in the laryn-geal mask general anesthesia group,while Esketamine-assisted brachial plexus block anesthesia was given in Esketamine group.Brachial plexus block anesthesia,anesthesia induction and anesthesia maintenance were the same in the two groups.Anesthesia-related indexes[duration of operation,length of postanesthesia care unit(PACU)stay,postoperative recovery time,Behavioral Pain Assessment Scale score]were compared between the two groups.The changes of mean arterial pressure(MAP)and heart rate(HR)before anesthesia(T0),at incision(T1),at 30 min after surgery(T2),at the end of surgery(T3),and at the time of recovery(T4),as well as OAA/S score and bispectral(BIS)index at T0,T1,T2 and T3 were compared.The levels of stress injury indexes[cortisol(Cor),epinephrine(E),norepinephrine(NE)and blood glucose]before and at 1 d after surgery,and the adverse reactions of anesthesia in the two groups were recorded.Results Length of PACU stay and postoperative recovery time in Esketamine group were shorter than those in laryngeal mask anesthesia group(P<0.01).MAP and HR in the two groups increased first and then decreased at T0-T4,which were higher in Esketamine group than in laryngeal mask general anesthesia group at T1,T2 and T3(P<0.05),but there was no statistical significance at T0 and T4(P>0.05).OAA/S scores and BIS values in the two groups decreased first and then increased at T0-T3,which were slightly higher in Esketamine group than in laryngeal mask general

关 键 词：上肢手术 儿童 麻醉 艾司氯胺酮 血流动力学 警觉/镇静观察评分 应激损伤 

分 类 号：R614[医药卫生—麻醉学]