摘要
目的 探索七氟烷麻醉下低剂量的氯胺酮复合右美托咪定在小儿扁桃体腺样体切除术中的术后谵妄发生率和其他麻醉不良反应。方法 共90名接受扁桃体腺样体切除术的患儿被分成试验组(45例)及对照组(45例)。手术期间使用七氟烷诱导和维持麻醉。手术结束前10 min,试验组患儿接受0.15 mg/kg低剂量的氯胺酮静脉注射,随后给予0.3μg/kg的右美托咪定静脉注射。对照组患儿接受与体重匹配的生理盐水静脉注射。术后谵妄和疼痛情况分别使用儿童麻醉苏醒期谵妄(PAED)量表和客观疼痛评分(OPS)进行评估。记录患儿临床信息、术中及术后麻醉情况。结果 试验组患儿的术后谵妄发生率和严重程度显著低于对照组(11.11%vs. 28.89%, 2.22%vs. 13.33%,均P<0.05)。试验组患儿中苏醒后PAED得分和OPS最高分显著低于对照组(均P<0.05);同时,试验组患儿中OPS>4分的比例为15.56%,显著低于对照组的62.22%(P<0.05)。与对照组16例(35.56%)比较,试验组中需要补充芬太尼镇静镇痛的患儿为6例(13.33%)。试验组患儿麻醉结束到睁眼的时间及麻醉结束到拔除气管插管的时间显著长于对照组(均P<0.05)。结论 手术结束前10 min加入低剂量的氯胺酮和右美托咪定可使得小儿扁桃体腺样体切除术后谵妄和严重术后谵妄的发生率和持续时间降低,且氯胺酮复合右美托咪定的使用方式和剂量安全可靠,不会导致不良反应发生率增加。
Objective To investigate whether low-dose ketamine combined with dexmedetomidine could reduce the rate of postoperative delirium under sevoflurane anesthesia and at the same time would not increase other anesthetic side effects of tonsillectomy in children under sevoflurane anesthesia.Methods A total of 90 child patients who underwent tonsillectomy were equally divided into the experimental group(n=45) and the control group(n=45). Sevoflurane was used to induce and maintain anesthesia. Ten minutes before end of surgery, the children in the experimental group received low-dose ketamine at a dosage of 0. 15 mg/kg intravenously, followed by an intravenous injection of dexmedetomidine at a dosage of 0. 3 μg/kg. The patients in the control group received weight-dependent volume matched normal saline intravenously. Postoperative delirium and pain were assessed by pediatric anesthesia emergence delirium(PAED) scale and objective pain scale(OPS). Related clinical data during anesthesia and patient conditions were recorded after surgery.Results The rate and severity of postoperative delirium in the experimental group were significantly lower than those in the control group(11. 11% vs. 28. 89%, 2. 22% vs. 13. 33%, all P<0. 05). In addition, the PAED scores and the highest OPS scores in the patients of the experimental group after wake up were also significantly lower than those in the control group(both P<0. 05). At the same time, the proportion of OPS>4 points in the experimental group was 15. 56%, which was significantly lower than 62. 22% in the control group(P<0. 05). Compared with the 16 patients(35. 56%) in the control group, there were only 6 patients(13. 33%) in the experimental group who required supplemental sedation and analgesia with fentanyl. The time from the termination of anesthesia to eye opening of the patients and the time from the termination of anesthesia to the removal of tracheal intubation in the experimental group were significantly longer than those in the control group(all P<0. 05).Conclusion The supplementation of low-dose ketamine and dexmedetomidine about 10 minutes before end of surgery could reduce the rate and length of pediatric post-tonsillectomy delirium and severity of post-operative delirium. The usage and dosage of ketamine and dexmedetomidine in this study were safe, and will not induce higher rate of adverse reactions.
作者
徐红梅
周红刚
胡秀改
刘晶
Xu Hongmei;Zhou Honggang;Hu Xiugai;Liu Jing(Department of Anesthesiology,Branch Hospital of Huai’an First People’s Hospital,Jiangsu Province,Huai’an 223002,China)
出处
《海军医学杂志》
2022年第12期1335-1339,共5页
Journal of Navy Medicine
关键词
氯胺酮
右美托咪定
七氟烷
小儿麻醉
术后谵妄
Ketamine
Dexmedetomidine
Sevoflurane
Pediatric anesthesia
Postoperative delirium
