艾司氯胺酮在儿童斜视矫正术中的应用效果研究  

Study on the effect of Esketamine in children undergoing strabismus correction surgery

作　　者：丁艺超 孙作君 瞿静语 张静 韩邦桂 曾永恒 DING Yichao;SUN Zuojun;QU Jingyu;ZHANG Jing;HAN Banggui;ZENG Yongheng(Eye Institute of Shandong First Medical University/Qingdao Eye Hospital of Shandong First Medical University,Qingdao 266071,Shandong Province,China;State Key Laboratory Cultivation Base,Shandong Key Laboratory of Eye Diseases,Qingdao 266071,Shandong Province,China;School of Ophthalmology,Shandong First Medical University,Qingdao 266071,Shandong Province,China)

机构地区：[1]山东第一医科大学附属眼科研究所/山东第一医科大学附属青岛眼科医院,山东青岛266071 [2]山东省眼部疾病重点实验室-省部共建国家重点实验室培育基地,山东青岛266071 [3]山东第一医科大学眼科学院,山东青岛266071

出　　处：《医学新知》2025年第4期430-435,共6页New Medicine

基　　金：国家自然科学基金青年科学基金项目(82401216)。

摘　　要：目的探讨艾司氯胺酮在儿童斜视手术中的应用效果。方法以择期拟行斜视矫正术的患儿为研究对象,分为艾司氯胺酮组(艾司组)和芬太尼组(对照组)。艾司组静脉注射艾司氯胺酮0.5 mg/kg进行麻醉诱导,对照组静脉注射芬太尼2μg/kg进行麻醉诱导。两组均静脉泵注瑞芬太尼0.1~0.3μg/kg/min维持麻醉。观察记录全部患儿诱导前、诱导后60 s、术毕时的舒张压、收缩压和心率等;麻醉恢复期间患儿FLACC镇痛评分及不良事件(恶心呕吐、幻觉、过度镇静、躁动)发生情况;术后一周及术后一月的眼位情况。结果共纳入86例患儿,艾司组和对照组各43例。在3个时间点,艾司组和对照组的舒张压与收缩压均无显著差异(P>0.05),艾司组心率均较对照组显著升高(P<0.05)。艾司组患儿FLACC镇痛评分显著优于对照组(P<0.05)。两组不良事件发生率无显著差异(P>0.05)。两组术后1周及1月的正位率均无显著差异(P>0.05)。结论在儿童斜视手术中艾司氯胺酮较芬太尼具有更好的镇痛效果,且不显著增加副作用、不影响术后眼位。Objective To investigate the effect of Esketamine in children undergoing strabismus correction surgery.Methods Children who were scheduled to undergo strabismus surgery were divided into the Esketamine group(ES group)and Fentanyl group(control group).Esketamine 0.5 mg/kg was injected intravenously for anesthesia induction in the ES group,and Fentanyl 2μg/kg was administered intravenously for anesthesia induction in the control group.Remifentanil 0.1~0.3μg/kg/min was injected intravenously to maintain anesthesia in both groups.The diastolic blood pressure,systolic blood pressure and heart rate of all children before induction,60 seconds after induction,and after the operation were observed and recorded in all children.Children's FLACC analgesia scores and occurrence of adverse events(nausea and vomiting,hallucinations,excessive sedation,agitation),eye position one week after surgery and one month after surgery during recovery from anaesthesia were also recorded.Results A total of 86 pediatric patients were included,with 43 in the ES group and 43 in the control group.At the three time points,there was no significant difference in diastolic and systolic blood pressure between the two groups(P>0.05),but heart rate in the ES group was significantly higher than the contorl group(P<0.05).The FLACC score of the ES group was higher than that of the control group(P<0.05).There was no difference in the incidence of adverse events between two groups(P>0.05).The orthotopic rates at 1 week and 1 month after surgery had no significant differences between two groups(P>0.05).Conclusion In pediatric strabismus surgery,Esketamine has a better analgesic effect than Fentanyl,and does not significantly increase side effects or affect postoperative eye position.

关 键 词：斜视矫正术 艾司氯胺酮 麻醉效果 眼位 副作用 儿童 

分 类 号：R779.7[医药卫生—眼科] R971.2[医药卫生—临床医学]