艾司氯胺酮复合丙泊酚对小儿腹股沟疝及鞘膜积液腹膜外结扎术后疼痛的影响

Effect of esketamine combined with propofol on pain after extraperitoneal ligation in children with inguinal hernia and hydrocele

摘要:

目的 分析艾司氯胺酮复合丙泊酚对小儿腹股沟疝及鞘膜积液腹膜外结扎术后疼痛的影响。方法 选取2019年10月—2022年4月南通市妇幼保健院收治的118例腹股沟疝及鞘膜积液患儿为研究对象，用随机数表法分为对照组和研究组，每组59例。两组均行全身麻醉，对照组给予瑞芬太尼、丙泊酚维持麻醉，研究组给予艾司氯胺酮、丙泊酚维持麻醉。记录两组术中血流动力学指标变化情况及手术情况，比较两组围手术期苏醒、躁动及应激反应情况，对比两组围手术期疼痛及麻醉药物相关不良反应发生情况。结果 两组麻醉诱导前（T₀）、气腹建立后1 min（T₁）、放气后1 min（T₂）的心率、平均动脉压（MAP）比较，不同时间点间的心率、MAP有差异（P <0.05），研究组的心率、MAP低于对照组（P <0.05），研究组与对照组的心率、MAP变化趋势有差异（P <0.05）。研究组与对照组手术时间比较，差异无统计学意义（P >0.05）。研究组自主呼吸恢复时间短于对照组（P <0.05），两组术后苏醒时间、术后拔管时间比较，差异均无统计学意义（P >0.05）。研究组躁动程度低于对照组（P <0.05）。两组术前、术后24 h、术后48 h的肾上腺素（Adr）、皮质醇（Cor）比较，不同时间点间的Adr、Cor有差别（P <0.05），两组的Adr、Cor有差异（P <0.05），两组Adr、Cor的变化趋势有差别（P <0.05）。两组术后4 h、12 h、24 h、48 h的东安大略儿童医院疼痛评分（CHEOPS）比较，不同时间点的CHEOPS评分有差异（P <0.05），两组的CHEOPS评分有差异（P <0.05），两组CHEOPS评分的变化趋势有差异（P <0.05）。两组总不良反应发生率比较，差异无统计学意义（P >0.05）。结论 艾司氯胺酮复合丙泊酚用于小儿腹股沟疝及鞘膜积液术可稳定术中血流动力学指标，降低围手术期躁动发生风险，抑制围手术期应激反应，减轻术后疼痛，且安全性良好。

Abstract:

Objective To analyze the effect of esketamine combined with propofol on pain after extraperitoneal ligation in children with inguinal hernia and hydrocele.Methods A total of 118 children with inguinal hernia and hydrocele admitted to our hospital from October 2019 to April 2022 were selected as the research objects, and were divided into control and study group by random number table method, with 59 cases in each group. The control group was given remifentanil and propofol for maintenance anesthesia, while the research group was given esticketamine and propofol for maintenance anesthesia. The changes of intraoperative hemodynamic indexes and surgery of the two groups were recorded. Perioperative resuscitation, agitation, and stress response were compared between the two groups. The incidence of perioperative pain and narcotics-related adverse reactions was compared between the two groups.Results Comparison of heart rate and mean arterial pressure (MAP) between the study group and the control group before anesthesia induction (T₀), at 1 min after pneumoperitoneal establishment (T₁), and at 1 min after ventilation (T₂) showed differences in heart rate and MAP at different time points (P < 0.05). The heart rate and MAP of the study group were lower than that of the control group (P < 0.05). There were differences in heart rate and MAP between the study group and the control group (P < 0.05). There was no significant difference in operation time between the study group and the control group (P > 0.05). The recovery time of spontaneous breathing in the study group was lower than that in the control group (P < 0.05). There was no significant difference in postoperative recovery time and postoperative extubation time between the two groups (P > 0.05). The degree of agitation in the study group was lower than that in the control group (P < 0.05). Comparison of adrenalin (Adr) and cortisol (Cor) between the study group and the control group before, at 24 h, and 48h after surgery showed differences in Adr and Cor at different time points (P < 0.05), and the comparison of Adr and Cor between the study group and the control group was lower (P < 0.05). The changes of Adr and Cor in phase study group and control group were different (P < 0.05). Comparison of the Eastern Ontario Children's Hospital Pain Score (CHEOPS) scores at 4 h, 12 h, 24 h, and 48 h after surgery between the two groups showed differences in CHEOPS scores at different time points (P < 0.05). The CHEOPS scores of the study group were lower than those of the control group (P < 0.05). The CHEOPS scores of the study group and the control group were different (P < 0.05). There was no significant difference in the incidence of total adverse reactions between the two groups (P > 0.05).Conclusion The use of esticketamine combined with propofol after extraperitoneal ligation in children with inguinal hernia and hydrocele can stabilize intraoperative hemodynamic indexes, reduce the risk of perioperative agitation, inhibit perioperative stress response, and relieve postoperative pain with good safety.