| 摘要: |
| 目的:探讨艾司氯胺酮不同暴露水平在小儿扁桃体切除术中的镇静作用。 方法:选取 2021 年 4 月至 2024 年 4 月于我院 行扁桃体切除术的 126 例患儿,按随机数表法分为 R1 组(艾司氯胺酮 0. 25 mg / kg)、R2 组(艾司氯胺酮 0. 50 mg / kg)、R3 组(艾司 氯胺酮 0. 75 mg / kg)各 42 例。 比较 3 组患儿一般资料,记录麻醉诱导前(T0)、麻醉诱导后(T1)、插管时(T2)、拔管时(T3)3 组 患儿生命体征变化及波动幅度,记录术后评分及不良反应发生情况。 采用序贯法测定丙泊酚抑制体动反应的半数有效浓度 (EC50)。 结果:3 组患儿心率(HR)、平均动脉压(MAP)水平术中有上升,血氧饱和度(SpO2 )下降。 T1、T2 时,R2、R3 组的 MAP 均低于 R1 组(P<0. 05)。 T3 时,R3 组 HR 低于 R1 组(P<0. 05),R1 组 SpO2 低于 R2、R3 组(P<0. 05)。 R1 组 HR、MAP 及 SpO2 的波动幅度大于 R2 组与 R3 组(P<0. 05)。 术后 R3 组 Ramsay 评分高于 R1、R2 组(P<0. 05),R2、R3 组麻醉苏醒期躁动量表 (PAED)评分和疼痛行为评分量表(FLACC)评分高于 R1 组(P<0. 05)。 R1、R2、R3 组丙泊酚 EC50 分别为 5. 130、5. 518、5. 984 μg / mL。 艾司氯胺酮给药剂量是影响小儿扁桃体切除术中丙泊酚 EC50 的保护因素(P<0. 05)。 Log-binomial 模型回归分析结果显示,R3 组不良事件总发生风险高于 R1 组(P<0. 05)。 结论:0. 25 mg / kg 艾司氯胺酮对应最低丙泊酚 EC50,0. 25 mg / kg 镇静效果较好,可 减轻患儿术后疼痛和不良反应,改善患儿术后短期预后情况,值得临床推广应用。 |
| 关键词: 艾司氯胺酮 儿童 扁桃体切除术 丙泊酚 半数有效浓度 |
| DOI：10.13407/j.cnki.jpp.1672-108X.2026.09.005 |
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| 基金项目: |
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| Sedative Effects and Dose-Response Correlation of Different Induction Doses of Esketamine in Pediatric Tonsillectomy |
| Cai Yajiao, Zhang Xiaonan, Li Xiaoli |
| (Shijiazhuang Maternal and Child Health Hospital, Shijiazhuang 050000, China) |
| Abstract: |
| Objective: To explore the sedative effects of different exposure levels of esketamine on pediatric tonsillectomy. Methods: A total of 126 children who underwent tonsillectomy at our hospital from Apr. 2021 to Apr. 2024 were extracted to be divided into the R1 group (0. 25 mg / kg esketamine), R2 group ( 0. 50 mg / kg esketamine), and R3 group ( 0. 75 mg / kg esketamine) via the random number table method, with 42 children in each group. The general data of three groups were compared, changes and fluctuations in vital signs were recorded before anesthesia induction ( T0), after induction ( T1), during induction ( T2), and during extubation ( T3). Postoperative scores and adverse drug reactions were recorded. The sequential method was used to detect the half effective concentration (EC50) of propofol for inhibiting the motor response. Results: During surgery, heart rate (HR) and mean arterial pressure (MAP) increased in three groups of children, while blood oxygen saturation (SpO2 ) decreased. At T1 and T2, MAP in R2 group and R3 group was lower than that in R1 group (P<0. 05). At T3, HR in R3 group was lower than in R1 group (P<0. 05), and SpO2 in R1 group was lower than that in R2 group and R3 group (P<0. 05). The fluctuations of HR, MAP, and SpO2 in R1 group were significantly greater than those in R2 group and R3 group (P<0. 05). Postoperatively, the Ramsay score in R3 group was higher than that in R1 group and R2 group (P<0. 05), and the Pediatric Anesthesia Emergence Delirium (PAED) and Face, Legs, Activity, Cry, Consolability (FLACC) pain behavior scores in R2 group and R3 group were higher than those in R1 group (P<0. 05). The EC50 of propofol in R1 group, R2 group, and R3 group was 5. 130, 5. 518, and 5. 984 μg / mL, respectively. The dose of esketamine administered was a protective factor affecting the EC50 of propofol during pediatric tonsillectomy (P<0. 05). Log-binomial regression analysis showed that the overall risk of adverse events in R3 group was significantly higher than that in R1 group (P<0. 05). Conclusion: A dose of 0. 25 mg / kg esketamine corresponds to the lowest EC50 of propofol, sedation effect of 0. 25 mg / kg is better, providing better sedation, alleviating postoperative pain and adverse drug reactions in children, and improving short-term postoperative outcomes, which can be promoted for clinical application. |
| Key words: esketamine children tonsillectomy propofol half effective concentration |
