目的

研究右旋氯胺酮与舒芬太尼用于腹腔镜疝囊高位结扎术患儿全身麻醉对术中血流动力学及术后自主恢复的影响。

方法

回顾性选取2022 年2 月至2023 年5 临泉县人民医院开展腹腔镜疝囊高位结扎术的患儿88 例，采用随机数字表将患儿分为观察组和对照组，各44 例。2组均于静脉吸入复合麻醉下完成腹腔镜疝囊高位结扎术。观察组麻醉诱导方案为顺式阿曲库铵0.05 mg/kg、丙泊酚3 mg/kg、右旋氯胺酮0.5 mg/kg 以及山莨菪碱0.1 mg/kg 静脉滴注；对照组将右旋氯胺酮改为舒芬太尼0.2 μg/kg 静脉滴注，2 组术中均采用七氟醚维持麻醉。比较2 组围手术期指标、血流动力学、中文版儿童疼痛行为量表评分、术后苏醒质量以及不良反应。

结果

2 组气管插管即刻（T2）心率（HR）显著升高（P＜0.05），T2 至术毕即刻（T5）时平均动脉压（MAP）均显著升高（P＜0.05），且观察组T2 时HR 低于对照组，T2～T5 时MAP 低于对照组，差异有统计学意义（P＜0.05）；观察组术后24 h 补救镇痛比例低于对照组，差异有统计学意义（P＜0.05）；观察组术后自主呼吸恢复时间、麻醉苏醒时间以及苏醒躁动发生率均低于对照组，差异有统计学意义（P＜0.05）；2 组心动过缓、低血压及恶心呕吐等不良反应发生率差异无统计学意义（P＞0.05）。

结论

右旋氯胺酮用于腹腔镜疝囊高位结扎术患儿全身麻醉有利于维持围手术期血流动力学稳定，增强术后镇痛效果，缩短麻醉苏醒时间并降低苏醒躁动发生风险。

Objective

To study the effect of general anesthesia with S(+)-ketamine and sufentanil on intraoperative hemodynamics and postoperative spontaneous recovery in children undergoing laparoscopic high ligation of hernia sac.

Methods

A total of 88 children who underwent laparoscopic high ligation of hernia sac in Linquan County People's Hospital from February 2022 to May 2023 were selected and divided into observation group and control group with 44 cases in each group by the random number table method.Both groups underwent laparoscopic high ligation of hernia sac under intravenous-inhalation general anesthesia.The anesthesia induction regimen in the observation group was cis-atracurium (0.05 mg/kg),propofol (3 mg/kg), S(+)-ketamine (0.5 mg/kg) and anisodamine (0.1 mg/kg) intravenous drip, while the control group was changed from S(+)-ketamine to sufentanil (0.2 μg/kg) intravenous drip, and sevoflurane was used to maintain anesthesia in both groups.Perioperative indicators, hemodynamics, the Chinese version face, legs, activity, cry, consolability behavioral tool scale score, postoperative recovery quality and adverse reactions were compared between the two groups.

Results

The heart rate (HR) immediately after tracheal intubation (T2) was significantly increased in both groups (P<0.05), and the mean arterial pressure (MAP)from T2 to immediately after the end of surgery (T5) was significantly increased (P<0.05).HR at T2 in observation group was lower than that in control group, and MAP at T2-T5 was lower than that in control group, the difference was statistically significant (P<0.05).The proportion of remedial analgesia at 24 hours after surgery was lower in observation group than that in control group, the difference was statistically significant (P<0.05).The postoperative spontaneous breathing recovery time, anesthesia recovery time and incidence rate of recovery agitation in observation group were lower compared with those in control group,the differences were statistically significant (P<0.05).There were no statistically significant differences in the incidence rates of adverse reactions such as bradycardia, hypotension and nausea and vomiting between the two groups (P>0.05).

Conclusion

The application of S(+)-ketamine for general anesthesia in children undergoing laparoscopic high ligation of hernia sac is beneficial to maintaining perioperative hemodynamic stability, enhancing postoperative analgesia effect, shortening anesthesia recovery time and reducing the risk of recovery agitation.