术前静脉注射艾司氯胺酮对学龄前儿童镇静及诱导合作的临床观察

doi:10.11958/20212781

天津医药 ›› 2022, Vol. 50 ›› Issue (9): 984-987.doi: 10.11958/20212781

术前静脉注射艾司氯胺酮对学龄前儿童镇静及诱导合作的临床观察

王君霞¹(), 黄鑫², 王林林³, 胡卫东³, 张彬³^,^△()

1 山东第一医科大学第一附属医院儿科（邮编250000）
2 山东大学公共卫生学院
3 山东大学齐鲁儿童医院麻醉科

收稿日期:2022-01-04 修回日期:2022-03-31 出版日期:2022-09-15 发布日期:2022-09-05
通讯作者: 张彬 E-mail:378072589@qq.com;qletyymzk@sina.com
作者简介:王君霞（1980）,女,主治医师,主要从事儿科诊疗方面研究。E-mail： 378072589@qq.com
基金资助:
山东省医学会舒适化医疗基金(YXH2020ZX025)

Clinical observation of preoperative intravenous administration of esketamine on sedation and induction compliance in preschool children

WANG Junxia¹(), HUANG Xin², WANG Linlin³, HU Weidong³, ZHANG Bin³^,^△()

1 Department of Pediatrics, the First Affiliated Hospital of Shandong First Medical University, Ji'nan 250000, China
2 School of Public Health, Shandong University
3 Department of Anesthesiology, Qilu Children’s Hospital of Shandong University

Received:2022-01-04 Revised:2022-03-31 Published:2022-09-15 Online:2022-09-05
Contact: ZHANG Bin E-mail:378072589@qq.com;qletyymzk@sina.com

王君霞, 黄鑫, 王林林, 胡卫东, 张彬. 术前静脉注射艾司氯胺酮对学龄前儿童镇静及诱导合作的临床观察[J]. 天津医药, 2022, 50(9): 984-987.

WANG Junxia, HUANG Xin, WANG Linlin, HU Weidong, ZHANG Bin. Clinical observation of preoperative intravenous administration of esketamine on sedation and induction compliance in preschool children[J]. Tianjin Medical Journal, 2022, 50(9): 984-987.

摘要/Abstract

摘要：

目的探讨术前静脉注射不同剂量艾司氯胺酮对学龄前儿童镇静效果和麻醉诱导合作度的影响。方法全麻下行腹腔镜疝囊高位结扎术的患儿90例,年龄1~6岁。采用随机数字表法将患儿分为S₁组、S₂组和S₃组（静脉注射艾司氯胺酮的剂量分别为0.6、0.8和1.0 mg/kg）,每组30例。记录患儿用药前（T₀）、用药后1 min亲子分离时（T₁）和麻醉诱导时（T₂）的Ramsay镇静评分、心率及麻醉诱导合作量表（ICC）评分,镇静时与苏醒后的不良反应以及苏醒时间。结果 T₁和T₂时,S₂组和S₃组Ramsay镇静评分优于S₁组（P<0.05）,且T₂时S₃组Ramsay镇静评分高于S₂组（P<0.05）。S₃组ICC评分低于S₁组与S₂组（P<0.05）,S₁组与S₂组差异无统计学意义（P>0.05）。3组患儿ICC级别差异有统计学意义（P<0.05）。S₃组诱导合作完美（ICC=0分）的患儿比例显著高于S₁组和S₂组,诱导合作差（ICC=4~10分）的患儿比例显著低于S₁组和S₂组（P<0.05）。各组不良反应发生率与苏醒时间差异无统计学意义（P>0.05）。结论术前静脉注射艾司氯胺酮0.8 mg/kg和1.0 mg/kg均可提升学龄前儿童的术前镇静效果,但1.0 mg/kg的剂量麻醉诱导时镇静效果和诱导合作度更优。

关键词: 氯胺酮, 注射,静脉内, 深度镇静, 儿童,学龄前, 艾司氯胺酮, 诱导合作

Abstract:

Objective To explore the effect of preoperative intravenous administration of different doses of esketamine on sedation and anesthesia induction compliance in preschool children. Methods A total of 90 children scheduled for laparoscopic high ligation of hernia under general anesthesia were allocated, aged 1 to 6 years. The children were divided into the S₁ group, the S₂ group and the S₃ group (according to different intravenous doses of esketamine 0.6 mg/kg, 0.8 mg/kg and 1.0 mg/kg respectively) by random number table method, with 30 patients in each group. The Ramsay sedation score of children were recorded before medication (T₀), separating with parents 1 min after medication (T₁) and anesthesia induction (T₂). Induction Compliance Checklist (ICC) score and heart rate were also recorded. The adverse events during sedation and after recovery, and the recovery time were recorded. Results At T₁ and T₂, the Ramsay sedation score was better in the S₂ group and the S₃ group than that of the S₁group (P<0.05), and the Ramsay score of the S₃ group was higher than that of the S₂ group at T₂(P<0.05). The ICC score was lower in the S₃ group than that of the S₁group and the S₂ group (P<0.05). There was no significant difference in ICC score between the S₁group and the S₂ group (P>0.05). There were significant differences in ICC grades between the three groups (P<0.01). The proportion of children with perfect induction cooperation (ICC=0) was significantly higher in the S₃ group than that in the S₁ group and the S₂ group, and the proportion of children with poor induction cooperation (ICC=4-10) was significantly lower in the S₃ group than that in the S₁ group and the S₂ group (P<0.05). There were no significant differences in the incidence of adverse events and recovery time between the three groups (P>0.05). Conclusion Preoperative intravenous administration of esketamine 0.8 mg/kg and 1.0 mg/kg can improve the sedation effect of preschool children, but the sedation effect and induction compliance is superior with 1.0 mg/kg anesthesia induction.

Key words: Ketamine, injections,intravenous, deep sedation, child,preschool, Esketamine, induction compliance

中图分类号:

R726.14

图/表 5

参考文献 12

[1]	王月, 初丽艳, 王珊珊, 等. 术前动画视频陪伴改善学龄前儿童分离焦虑及诱导配合的临床观察[J]. 中华医学杂志, 2021, 101(26):2066-2070.
	WANG Y, CHU L Y, WANG S S, et al. Preoperative video distraction alleviates separation anxiety and improves induction compliance of preschool children: a randomized controlled clinical trial[J]. Natl Med J China, 2021, 101(26):2066-2070. doi: 10.3760/cma.j.cn112137-20201224-03458.
[2]	RYU J H, PARK S J, PARK J W, et al. Randomized clinical trial of immersive virtual reality tour of the operating theatre in children before anaesthesia[J]. Br J Surg, 2017, 104(12):1628-1633. doi: 10.1002/bjs.10684.
[3]	LI B, HOU H, BAI J, et al. Paediatric preoperative sedation practices in tertiary maternity and children's hospitals in China:a questionnaire survey[J]. BMC Pediatr, 2021, 21(1):336. doi: 10.1186/s12887-021-02802-0.
[4]	VAN DEN BOSCH O F C, ALVAREZ-JIMENEZ R, SCHET S G, et al. Breathing variability during propofol/remifentanil procedural sedation with a single additional dose of midazolam or s-ketamine:a prospective observational study[J]. J Clin Monit Comput, 2021. doi: 10.1007/s10877-021-00773-2. [Epub ahead of print].
[5]	BIAN Y, ZHOU S, HOU H, et al. The optimal dose of oral midazolam with or without intranasal S-ketamine for premedication in children:a randomised,double blinded,sequential dose-finding trial[J]. Transl Pediatr, 2021, 10(11):2941-2951. doi: 10.21037/tp-21-247.
[6]	罗秀英, 万丽. 重度癌痛患者鞘内植入镇痛装置居家管理的可行性分析[J]. 中华疼痛学杂志, 2021, 17(5):477-483.
	LUO X Y, WAN L. Feasibility of home management analgesia mode in severe cancer pain patients with intrathecal delivery port implantation[J]. Chin J Painol, 2021, 17(5):477-483. doi: 10.3760/cma.j.cn101658-20200424-00078.
[7]	PELTONIEMI M A, HAGELBERG N M, OLKKOLA K T, et al. Ketamine:A review of clinical pharmacokinetics and pharmacodynamics in anesthesia and pain therapy[J]. Clin Pharmacokinet, 2016, 55(9):1059-1077. doi: 10.1007/s40262-016-0383-6.
[8]	LI L Q, WANG C, XU H Y, et al. Effects of different doses of intranasal dexmedetomidine on preoperative sedation and postoperative agitation in pediatric with total intravenous anesthesia undergoing adenoidectomy with or without tonsillectomy[J]. Medicine(Baltimore), 2018, 97(39):e12140. doi: 10.1097/MD.0000000000012140.
[9]	MARHOFER P, FREITAG H, HOCHTL A, et al. S(+)-ketamine for rectal premedication in children[J]. Anesth Analg, 2001, 92(1):62-65. doi: 10.1097/00000539-200101000-00012.
[10]	刘丝濛, 岳云. 右氯胺酮的药理学特点和临床应用[J]. 国际麻醉学与复苏杂志, 2016, 37(1):62-66.
	LIU S M, YUE Y, et al. Pharmacology and clinical application of S-ketamin[J]. Int J Anesth Resus, 2016, 37(1):62-66. doi: 10.3760/cma.j.issn.1673-4378.2016.01.015.
[11]	CONWAY A, CHANG K, MAFELD S, et al. Midazolam for sedation before procedures in adults and children:a systematic review update[J]. Syst Rev, 2021, 10(1):69. doi: 10.1186/s13643-021-01617-5.
[12]	JIN E H, SONG J H, LEE J, et al. Midazolam dose is associated with recurrence of paradoxical reactions during endoscopy[J]. World J Clin Cases, 2021, 9(29):8763-8772. doi: 10.12998/wjcc.v9.i29.8763.

组别	年龄（岁）	性别（男/女）	体质量（kg）	手术时间（min）
S₁组	2.96±1.78	22/8	13.77±4.00	48.37±6.57
S₂组	2.30±1.01	23/7	13.12±2.88	47.50±5.88
S₃组	2.50±1.05	20/10	14.02±2.97	49.13±6.42
F或χ²	1.952	0.775	0.592	0.505

组别	年龄（岁）	性别（男/女）	体质量（kg）	手术时间（min）
S₁组	2.96±1.78	22/8	13.77±4.00	48.37±6.57
S₂组	2.30±1.01	23/7	13.12±2.88	47.50±5.88
S₃组	2.50±1.05	20/10	14.02±2.97	49.13±6.42
F或χ²	1.952	0.775	0.592	0.505

组别	T₀	T₁	T₂
S₁组	1.57±0.50	1.83±0.59	1.60±0.72
S₂组	1.43±0.50	4.57±0.82^a	3.20±1.79^a
S₃组	1.60±0.56	4.90±1.00^a	4.67±1.15^ab
F	0.848	126.890^＊＊	41.865^＊＊

组别	T₀	T₁	T₂
S₁组	1.57±0.50	1.83±0.59	1.60±0.72
S₂组	1.43±0.50	4.57±0.82^a	3.20±1.79^a
S₃组	1.60±0.56	4.90±1.00^a	4.67±1.15^ab
F	0.848	126.890^＊＊	41.865^＊＊

组别	ICC评分	ICC评分
组别	ICC评分	0	1~3	4~10
S₁组	3.83±3.26	5（16.7）	13（43.3）	12（40.0）
S₂组	2.63±3.00	14（46.7）	4（13.3）	12（40.0）
S₃组	0.90±2.02^ab	23（76.7）	3（10.0）	4（13.3）
χ²	8.252^＊＊		25.243^＊＊

术前静脉注射艾司氯胺酮对学龄前儿童镇静及诱导合作的临床观察

Clinical observation of preoperative intravenous administration of esketamine on sedation and induction compliance in preschool children

引用本文

RichHTML

PDF (PC)

可视化

摘要/Abstract

使用本文

图/表 5

参考文献 12

相关文章 9

编辑推荐

Metrics

本文评价

组别	T₀	T₁	T₂
S₁组	122.47±17.88	124.67±16.87	125.13±15.95
S₂组	124.30±21.95	124.97±18.19	123.97±16.23
S₃组	113.47±16.47	121.43±12.99	122.77±13.46
F	2.820	0.441	0.180

组别	苏醒时间（min）	T₂时（木僵）	PACU时
组别	苏醒时间（min）	T₂时（木僵）	烦躁不安	恶心呕吐
S₁组	39.83±11.69	0	6（20.0）	4（13.3）
S₂组	41.33±12.04	1（3.3）	6（20.0）	3（10.0）
S₃组	45.67±13.64	1（3.3）	8（26.7）	4（13.3）
F、P或χ²	1.766	1.265^▲	0.514	0.207

[1]	薛建铭, 孙硕, 郭云飞, 李晓敏, 李建玲. 艾司氯胺酮对学龄前扁桃体切除患儿术后不良行为改变的影响[J]. 天津医药, 2023, 51(9): 1002-1006.
[2]	任齐齐, 张伯康, 孔令锁. 艾司氯胺酮对老年患者胸腔镜下肺癌根治术后呼吸抑制的影响[J]. 天津医药, 2023, 51(11): 1267-1270.
[3]	何士凤, 朱泽飞, 张婉月, 杨贯宇, 郑红雨, 孙振涛△. 基于脑电小波指数的人工智能给药系统的临床应用[J]. 天津医药, 2022, 50(6): 648-652.
[4]	樊飞, 雷碧波. 氯胺酮和利多卡因对膝关节置换术患者止血带所致缺血再灌注损伤后自由基生成的影响[J]. 天津医药, 2022, 50(2): 181-185.
[5]	宋俊杰, 范军朝△, 陈英, 陈勇. 低剂量氯胺酮对MPTP诱导帕金森病小鼠神经功能及炎性因子的影响#br# #br#[J]. 天津医药, 2021, 49(5): 476-482.
[6]	彭金芝, 李晓东, 王乾兴. 氯胺酮滥用致认知障碍与海马改变的研究进展[J]. 天津医药, 2021, 49(4): 444-448.
[7]	李向前, 邴艳春, 杨婉容, 王鸿旻, 马静. 不同剂量氯胺酮静脉麻醉对乳腺区段切除术后早期认知功能的影响 #br#[J]. 天津医药, 2020, 48(4): 289-293.
[8]	蒋铭 1，杨现会 2△，王军 1，周彪 3，颜朋朋 1. 右美托咪定和氯胺酮在小儿扁桃体切除术中的作用[J]. 天津医药, 2017, 45(9): 984-987.
[9]	朱良振1 ,于永刚2 ,廖松柏2 ,刘刚2 ,于管天2 ,武英杰2 . K粉相关性膀胱炎患者膀胱组织中组胺受体的表达及临床意义[J]. , 2013, (10): 0-0 .