静脉注射不同药物对小儿腹腔镜手术恢复期躁动预防效果的随机对照试验
贵州医科大学 麻醉与心脏电生理课题组
翻译：赵游霄 编辑：赵游霄 审校：曹莹
目的：探讨右美托咪定和艾司氯胺酮在减轻儿童腹腔镜手术后恢复期躁动方面的效果。
方法：102 名年龄在 1 至 7 岁接受腹腔镜手术的患者被随机分为三组，每组分别在二氧化碳气腹结束时立即给予1 μg/kg右美托咪定、 0.3 mg/kg艾司氯胺酮或生理盐水。通过儿童镇静躁动量表（PAED）和 5 分躁动量表评估苏醒期躁动（EA）的发生情况。疼痛程度通过面部表情、腿部活动、活动度、哭闹和安抚性（FLACC）量表进行判断。记录三组患者的恢复时间、拔管时间和麻醉后监护室（PACU）停留时间。
结果：接受 1 μg/kg右美托咪定（8.8%）治疗的患者以及接受 0.3 mg/kg艾司氯胺酮（11.8%）治疗的患者，其苏醒期躁动的发生率低于接受生理盐水治疗的患者（35.5%；P = 0.009）。三组患者的麻醉后重症监护病房（PACU）出院时间在统计学上无显著差异（P > 0.05）。右美托咪定组的恢复时间和拔管时间明显延长（分别为 40.88 ± 12.95 分钟、42.50 ± 13.38 分钟），而生理盐水组分别为 32.56 ± 13.05 分钟、33.29 ± 11.30 分钟（P = 0.009，P = 0.010）。
结论：在小儿腹腔镜手术中采用二氧化碳气腹后，静脉注射 1 μg/kg的右美托咪定或 0.3 mg/kg的艾司氯胺酮能够有效降低苏醒期躁动的发生几率，且不会延长麻醉恢复室的停留时间。
原始文献：
Liang Z-J, Liang J-M, Nong X-L, et al. Effect of intravenous different drugs on the prevention of restlessness during recovery period of pediatric laparoscopic surgery: a randomized control trial [J]. Journal of Anesthesia,
Effect of intravenous different drugs on the prevention of restlessness during recovery period of pediatric laparoscopic surgery: a randomized control trial
Abstract
Purpose
To explored the impact of dexmedetomidine and esketamine in mitigating restlessness during the postoperative recovery phase following laparoscopic surgery in children.
Methods
102 individuals aged 1 to 7 years experiencing laparoscopic surgery were randomly allocated into three groups, each accepting 1 μg/kg of dexmedetomidine, 0.3 mg/kg of esketamine, or saline immediately at the end of carbon dioxide pneumoperitoneum. Emergence agitation (EA) occurrence was assessed by PAED scale and 5-point agitation scale. Pain was judged using Face, Legs, Activity, Cry, and Consolability (FLACC) scale. The recovery time, extubation time, and post-anesthesia care unit (PACU) stay time were recorded for all three groups.
Results
Patients administered 1 μg/kg of dexmedetomidine (8.8%) and individuals given 0.3 mg/kg of esketamine (11.8%) showed lower incidences of emergence agitation compared to those receiving saline (35.5%; P = 0.009). There was no statistically significant difference in the time to discharge from the PACU among the three groups of patients (P > 0.05). The recovery time and extubation time were notably extended in the dexmedetomidine group (40.88 ± 12.95 min, 42.50± 13.38 min) when compared to the saline group (32.56 ± 13.05 min, 33.29± 11.30 min; P = 0.009, P = 0.010).
Conclusion
Following CO2 pneumoperitoneum in pediatric laparoscopic surgeries, the intravenous administration of 1 μg/ kg dexmedetomidine or 0.3 mg/kg esketamine effectively lowers EA occurrence without extending PACU time.
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