艾司氯胺酮联合切口周围局部浸润麻醉对全麻腹股沟疝修补术患儿苏醒期躁动和疼痛-应激因子的影响  

Effect of esketamine combined with local infiltration anesthesia around the incision on pediatric anesthesia emergence delirium and pain-stress factors in children undergoing general anesthesia for inguinal hernia repair

作　　者：郜思远 乔孝武 杨军[1] 彭栋梁 GAO Si-yuan;QIAO Xiao-wu;YANG Jun;PENG Dong-liang(Department of Anesthesiology,the Third Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,Henan,CHINA;Department of Anesthesia and Perioperative Medicine,Gongyi People's Hospital,Gongyi 451200,Henan,CHINA)

机构地区：[1]河南中医药大学第三附属医院麻醉科,河南郑州450000 [2]巩义市人民医院麻醉与围术期医学科,河南巩义451200

出　　处：《海南医学》2025年第5期693-698,共6页Hainan Medical Journal

基　　金：河南省医学科技攻关计划项目(编号:LHGJ20210994)。

摘　　要：目的 探讨艾司氯胺酮联合切口周围局部浸润麻醉(LIA)对全麻腹股沟疝修补术患儿苏醒期躁动(PAED)和疼痛-应激因子的影响。方法 前瞻性选取2022年6月至2024年4月于河南中医药大学第三附属医院拟行全麻腹股沟疝修补术的117例患儿纳入研究,按随机数表法分为LIA组(L组)、艾司氯胺酮组(S组)和艾司氯胺酮联合LIA组(SL组)各39例。入室后即刻S组和SL组给予艾司氯胺酮0.3 mg/kg,L组给予等量生理盐水,麻醉诱导与麻醉维持方案一致,缝皮前L组和SL组给予0.2%罗哌卡因5 m L切口周围LIA,S组不予处理。比较三组患儿的临床观察指标、PAED发生率、严重程度,苏醒后1~5 h Ramsay镇静、可安慰性评估量表(FLACC)评分,术前及术后24 h、72 h时疼痛-应激因子[P物质(SP)、前列腺素E2 (PGE2)、前列腺素F2α (PGF2α)、皮质醇(Cor)]水平,同时比较两组患者的不良反应发生率。结果 三组患儿的苏醒时间、手术时间、PACU停留时间、拔管时间比较差异均无统计学意义(P>0.05),但SL组患儿的住院时间明显短于S组、L组,差异有统计学意义(P<0.05),而S组与L组患儿的住院时间比较差异无统计学意义(P>0.05);SL组患儿的PAED发生率为12.82%,明显低于S组的58.97%和L组的35.90%,且L组低于S组,PAED评分为(4.38±0.80)分,明显低于S组的(9.38±1.42)分和L组的(5.54±1.03)分,且L组明显低于S组,差异均有统计学意义(P<0.05);苏醒后3 h、4 h、5 h,SL组、L组患儿的Ramsay评分明显高于S组,差异有统计学意义(P<0.05),但SL组患儿的Ramsay评分与L组比较差异无统计学意义(P>0.05);SL组患儿的FLACC评分明显低于S组、L组,差异有统计学意义(P<0.05),但S组患儿的FLACC评分与L组比较差异无统计学意义(P>0.05);术后24 h、72 h时,SL组患儿的SP、PGE2、PGF2α、Cor水平明显低于S组、L组,且L组明显低于S组,差异均有统计学意义(P<0.05);SL组、S组和L组患儿的不良反应总发生率分别为35.90%、28Objective To investigate the effects of esketamine combined with local infiltration anesthesia(LIA)around the incision on pediatric anesthesia emergence delirium(PAED)and pain-stress factors in children undergoing general anesthesia for inguinal hernia repair.Methods A total of 117 children who were scheduled to undergo general anesthesia for inguinal hernia repair at the Third Affiliated Hospital of Henan University of Chinese Medicine from June 2022 to April 2024 were prospectively selected and included in the study.Patients were randomly divided into LIA group(group L),the esketamine group(group S),and the esketamine combined with LIA group(group SL).Each group had 39 cases.Immediately after entering the room,the group S and group SL were given 0.3 mg/kg of esketamine,while the group L was given an equal amount of saline.The anesthesia induction and maintenance protocols were consistent.Before skin suturing,the group L and group SL were given 0.2%ropivacaine 5 mL around the incision to induce LIA,while the group S was not treated.The clinical observation indicators,incidence and severity of PAED,Ramsay sedation scores,the Face,Legs,Activity,Cry,and Consolability(FLACC)Scale scores,preoperative and postoperative 24-hour and 72-hour pain-stress factors (substance P [SP], prostaglandin E2 [PGE2], prostaglandin F2α [PGF2α], cortisol [Cor]), and safety were compared among the three groups of children. Results There was no significant differencein the recovery time, operation time, PACU stay time, and extubation time among the three groups of children (P>0.05).However, group SL had a significantly shorter hospital stay compared to group S and group L (P<0.05), and there wasno significant difference between group S and group L (P>0.05). The EA incidence in group SL (12.82%) was significantlylower than that in group S (58.97%) and group L (35.90%), with group L also lower than group S (P<0.05).The PAED score was (4.38±0.80) points, which was significantly lower than (9.38±1.42) points in group S and (5.54±1.03) p

关 键 词：艾司氯胺酮 切口周围局部浸润麻醉 全麻手术 苏醒期躁动 疼痛 应激因子 

分 类 号：R726.1[医药卫生—儿科]