天津医药

天津医药 ›› 2025, Vol. 53 ›› Issue (5): 483-487.doi: 10.11958/20250512

• 临床研究 • 上一篇    下一篇

艾司氯胺酮对小儿四肢骨折术后辅助镇痛效果及预测模型构建

高岩(), 马伟, 张瑜, 李蕾()   

  1. 唐山市妇幼保健院麻醉科（邮编063000）
  • 收稿日期:2025-02-11 修回日期:2025-03-11 出版日期:2025-05-15 发布日期:2025-05-28
  • 通讯作者: △ E-mail：396223135@qq.com
  • 作者简介:高岩（1990），男，主治医师，主要从事临床麻醉方面研究。E-mail:844166504@qq.com
  • 基金资助:
    河北省医学科学研究重点课题计划项目(20240471)

Analgesic effect of esketamine in children with postoperative limb fracture and construction of forecasting model

GAO Yan(), MA Wei, ZHANG Yu, LI Lei()   

  1. Department of Anesthesiology, Tangshan Maternal and Child Health Hospital, Tangshan 063000, China
  • Received:2025-02-11 Revised:2025-03-11 Published:2025-05-15 Online:2025-05-28
  • Contact: △ E-mail：396223135@qq.com

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摘要：

目的 探讨小剂量艾司氯胺酮对小儿四肢骨折术后辅助镇痛的效果，并构建预测模型。方法 选取四肢骨折患儿215例，手术后使用艾司氯胺酮复合舒芬太尼行自控静脉镇痛（PCIA），根据镇痛效果分为效果良好组（154例）和效果不佳组（61例）。通过Logistic回归分析筛选艾司氯胺酮对小儿四肢骨折术后镇痛效果的影响因素，绘制列线图，构建预测模型并进行评价。结果 Logistic回归筛选出美国麻醉医师协会（ASA）分级Ⅱ级（OR=2.731，95%CI：1.207~6.180）、下肢骨折（OR=2.990，95%CI：1.474~6.063）、急诊手术（OR=2.726，95%CI：1.284~5.789）、手术时间长（OR=1.059，95%CI：1.032~1.088）是艾司氯胺酮镇痛效果不佳的独立危险因素，而术前镇痛（OR=0.338，95%CI：0.156~0.731）、术后冰敷（OR=0.761，95%CI：0.658~0.879）为独立保护因素（P<0.05）。构建的镇痛效果的预测模型为logit（P）=-8.140+1.005×ASA分级+1.095×骨折部位+1.003×手术类型-1.086×术前镇痛-0.274×术后冰敷+0.057×手术时间。列线图模型显示，ASA分级Ⅱ级、下肢骨折、急诊手术、无术前镇痛和无术后冰敷分别为20分、22.5分、20分、20分，手术时间每增加10 min，列线图增加11.5分。列线图模型预测艾司氯胺酮对小儿四肢骨折术后镇痛效果的曲线下面积（AUC）为0.827（95%CI：0.741~0.852），校准曲线Brier得分为0.146，校准斜率为0.601，拟合效果良好（Hosmer-Lemeshowχ2=2.271，P=0.972）。结论 艾司氯胺酮对小儿四肢骨折术后镇痛效果较好，构建的列线图模型在预测患儿镇痛效果方面具有较高的区分度和校准度。

关键词: 氯胺酮, 儿童, 四肢, 骨折, 镇痛, 预测模型

Abstract:

Objective To investigate the effect of low-dose esketamine on postoperative analgesia in children with limb fractures and to construct a prediction model. Methods A total of 215 children with limb fractures were selected. After surgery, patients received self-controlled intravenous analgesia (PCIA) with a combination of esketamine and sufentanil. According to the analgesic effect, patients were divided into the good effect group (154 cases) and the poor effect group (61 cases). Logistic regression analysis was used to identify the factors influencing the analgesic effect of esketamine on postoperative analgesia in children with limb fractures. A nomogram was created to evaluate the prediction model. Results Logistic regression identified the following independent risk factors for poor analgesic effect of esketamine: American Society of Anesthesiologists (ASA) classification of level II (OR=2.731, 95%CI: 1.207-6.180), lower limb fractures (OR=2.990, 95%CI: 1.474-6.063), emergency surgery (OR=2.726, 95%CI: 1.284-5.789) and long operation time (OR=1.059, 95%CI: 1.032-1.088). Independent protective factors included preoperative analgesia (OR=0.338, 95%CI: 0.156-0.731) and postoperative ice application (OR=0.761, 95%CI: 0.658-0.879). The prediction model for the analgesic effect was: logit(P) = -8.140 + 1.005 × ASA classification + 1.095 × fracture site + 1.003 × surgical type - 1.086 × preoperative analgesia - 0.274 × postoperative ice application + 0.057 × operation time. In the nomogram, ASA classification II, lower limb fractures, emergency surgery, no preoperative analgesia and no postoperative ice application were assigned 20, 22.5, 20 and 20 points, respectively. For every 10-minute increase in surgery time, the nomogram score increased by 11.5 points. The area under the curve (AUC) for the nomogram model in predicting the analgesic effect of esketamine was 0.827 (95%CI: 0.741-0.852), with a Brier score of 0.146 and a calibration slope of 0.601, indicating good calibration (Hosmer-Lemeshow χ2=2.271, P=0.972). Conclusion Esketamine provides effective postoperative analgesia for children with limb fractures. The constructed nomogram model demonstrates high discrimination and calibration in predicting the analgesic effect in children.

Key words: ketamine, child, extremities, fractures, analgesia, forecasting model

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