摘要
目的评估右美托咪定联合艾司氯胺酮喷鼻用于扁桃体腺样体切除手术患儿术前镇静的疗效。方法这项前瞻性、随机、双盲研究共招募了120例年龄在2~8岁之间,美国麻醉医师协会(ASA)身体状况分类为Ⅰ或Ⅱ级且计划接受扁桃体腺样体切除手术的患者。根据随机数字表法将患儿随机分为2μg/kg右美托咪定组(D组)38例、1.5mg/kg艾司氯胺酮组(S组)38例及1μg/kg右美托咪定+1 mg/kg艾司氯胺酮组(DS组)37例。在麻醉准备间给患儿鼻内用药,主要观察镇静成功率、次要结果包括镇静起效时间(达到密歇根大学镇静量表评分≥2分的时间)、静脉置管满意度、父母分离满意度、麻醉师对基于视觉模拟量表的诱导满意度评分、苏醒时间、PACU停留时间、术后补救镇痛人数及不良反应发生情况等。结果DS组镇静成功率显著高于D组和S组[34/37(91.9%),29/38(76.3%),21/38(55.3%);P<0.05]。3组镇静起效的时间中位数分别为24.0(20.8,33.3)min,31.0(26.0,40.0)min,17.0(14.0,20.0)min,DS组达到UMSS评分为2分的时间最短(P<0.05),DS组镇静起效时间明显短于D组(P<0.05)和S组(P<0.05)。DS组静脉置管满意度最高,3组不良反应发生率相似(P>0.05)。结论右美托咪定联合艾司氯胺酮喷鼻镇静成功率更高,镇静起效时间更短,置管满意度更高,且不增加不良反应发生率。
Objective The objective of this study was to evaluate the efficacy of dexmedetomidine combined with esketamine nasal spray for preoperative sedation in children undergoing tonsillectomy.Methods This prospective,randomized,double-blind study recruited 120 patients from the ages of 2 to 8 years,with American Society of Anesthesiologists(ASA)physical status classification of Ⅰ or Ⅱ and scheduled to undergo tonsil adenoidectomy.The children were randomized into three groups according to the random number table method:2μg/kg dexmedetomidine group(group D,n=38),1.5mg/kg esketamine group(group S,n=38),and 1ug/kg dexmedetomidine+1mg/kg esketamine group(group DS,n=37).Intranasal medication was administered to the children in anesthesia preparations,and the primary observation was the sedation success rate;secondary outcomes included sedation onset time(time to achieve a University of Michigan Sedation Scale score of≥2),satisfaction with intravenous cannula placement,satisfaction with parental separation,anesthesiologist satisfaction scores with induction based on a visual analog scale,time to awakening,time to stay in the PACU,number of postoperative remedial analgesics,and the occurrence of adverse events.Results The sedation success rate was significantly higher in the DS group than in the D and S groups(34/37(91.9%)vs 29/38(76.3%)vs 21/38(55.3%);P<0.05).The median time to sedation onset in the three groups was 24.0(20.8,33.3),31.0(26.0,40.0),and 17.0(14.0,20.0)minutes,respectively,and the DS group had the shortest time to reach a UMSS score of 2(P<0.05),and the sedation onset time in the DS group was significantly shorter than that in the D(P<0.05)and S groups(P<0.05).The DS group had the highest satisfaction with intravenous cannula placement,and the incidence of adverse reactions was similar in the three groups(P>0.05).Conclusion Dexmedetomidine combined with esketamine nasal spray sedation has a higher success rate,shorter onset of sedation,and higher satisfaction with tube placement without increasing the incidence of adverse events.
作者
程香香
胡慧中
张广磊
张冠军
张平
张涛
李仁虎
邬薇薇
CHENG Xiangxiang;HU Huizhong;ZHANG Guanglei;ZHANG Guanjun;ZHANG Ping;ZHANG Tao;LI Renhu;WU Weiwei(Graduate School of Wannan Medical College,Wuhu 241003,Anhui,China;Department of Anesthesiology,Lu'an Hospital Affiliated to Anhui Medical University,Lu'an 237005,Anhui,China;Department of Anesthesiology,The First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)
出处
《西部医学》
2025年第9期1326-1330,1337,共6页
Medical Journal of West China
基金
安徽医科大学校科研基金项目(2022xkj200)
六安市科技计划项目(2023lakj017)。
