瑞马唑仑联合艾司氯胺酮对扁桃体腺样体切除术患儿的影响研究

Effects of remimazolam combined with esketamine in children undergoing tonsillectomy and/or adenoidectomy

摘要:

目的 探讨瑞马唑仑联合艾司氯胺酮用于扁桃体腺样体切除术患儿的效果及其对生命体征、苏醒期躁动和麻醉期间不良反应的影响。方法 选取2024年10月—2025年10月于阜阳市人民医院行扁桃体或（和）腺样体切除术的106例患儿，采用随机数字表法分为对照组（丙泊酚联合舒芬太尼，53例）和观察组（瑞马唑仑联合艾司氯胺酮，53例）。比较两组患儿麻醉情况［麻醉时间、自主呼吸恢复时间、拔管时间、唤醒时间、麻醉后监护室（PACU）停留时间］、不同时间点生命体征［平均动脉压（MAP）、心率（HR）］、苏醒期躁动情况［苏醒即刻、苏醒5 min、苏醒10 min、苏醒20 min时的儿童苏醒期躁动评分（PAED）］及麻醉期间不良反应发生率。结果 观察组麻醉时间、拔管时间、唤醒时间和PACU停留时间均短于对照组（P <0.05）。观察组和对照组麻醉前5 min、插管时、插管后5 min、拔管时的MAP、HR比较，结果 ①不同时间点MAP、HR比较，差异有统计学意义（P <0.05）；②观察组与对照组MAP、HR比较，差异有统计学意义（P <0.05）；③两组MAP、HR变化趋势比较，差异有统计学意义（P <0.05）。观察组苏醒期各时间点PAED评分均低于对照组（P <0.05），苏醒期躁动程度更轻。观察组不良反应总发生率低于对照组（P <0.05）。结论 瑞马唑仑联合艾司氯胺酮用于扁桃体腺样体切除术患儿，可缩短麻醉恢复时间，稳定围手术期血流动力学，减轻苏醒期躁动，降低不良反应风险，安全性及有效性均优于丙泊酚联合舒芬太尼方案。

Abstract:

Objective To explore the anesthetic effects of remimazolam combined with esketamine in children undergoing tonsillectomy and/or adenoidectomy, and its influences on vital signs, emergence agitation and anesthesia-related adverse reactions.Methods A total of 106 children who underwent tonsillectomy and/or adenoidectomy at our hospital from October 2024 to October 2025 were selected. They were randomly divided into the control group (propofol plus sufentanil, n = 53) and the observation group (remimazolam plus esketamine, n = 53) via the random number table. The anesthetic outcomes, including anesthesia duration, spontaneous respiration recovery time, extubation time, awakening time, and post-anesthesia care unit (PACU) stay, were compared between the two groups. Vital signs, including mean arterial pressure (MAP) and heart rate (HR), were recorded at different time points. Emergence agitation was evaluated using the Pediatric Anesthesia Emergence Delirium (PAED) score immediately after awakening and at 5, 10, and 20 minutes after awakening. The incidence of adverse events during anesthesia was also compared between the two groups.Results The observation group had significantly shorter anesthesia duration, extubation time, awakening time, and PACU stay than the control group (all P < 0.05). Comparisons of MAP and HR between the observation and control groups at 5 min before anesthesia, at intubation, 5 min after intubation, and at extubation showed that MAP and HR differed significantly across time points (P < 0.05) and between the two groups (P < 0.05), and that the trends of MAP and HR changes over time differed significantly between the two groups (P < 0.05). PAED scores at all assessed time points during emergence were significantly lower in the observation group than in the control group (P < 0.05), indicating less severe emergence agitation. The overall incidence of adverse events was significantly lower in the observation group than in the control group (P < 0.05).Conclusion Remimazolam combined with esketamine for pediatric tonsillectomy and/or adenoidectomy can shorten recovery from anesthesia, maintain perioperative hemodynamic stability, alleviate emergence agitation, and reduce the risk of adverse events. This regimen demonstrates superior safety and efficacy compared with propofol combined with sufentanil.