艾司氯胺酮对扁桃体切除术联合鼻内镜下腺样体切除术的影响

Effect of esketamine on tonsillectomy combined with endoscopic-assisted transoral adenoidectomy

摘要:

目的 探讨艾司氯胺酮对扁桃体切除术（TE）联合鼻内镜下腺样体切除术（ETA）患儿术后镇痛效果、应激反应及血清肿瘤坏死因子-α（TNF-α）和白细胞介素-1β（IL-1β）水平的影响。方法 选择2023年1月－2023年8月该院收治的扁桃体伴腺样体肥大患儿98例，随机分为两组，各49例。两组患儿均行TE联合ETA，并给予相同的麻醉诱导和维持，于手术结束前20 min，观察组静脉注射0.5 mg/kg艾司氯胺酮，对照组静脉注射等量生理盐水。观察两组患儿手术和麻醉恢复情况。比较两组患儿拔管即刻（T₁）、拔管后10 min（T₂）、拔管后20 min（T₃）、拔管后30 min（T₄）和拔管后60 min（T₅）儿童行为疼痛评估量表（FLACC）和小儿麻醉苏醒期谵妄量表（PAED）评分。分别于入室建立心电监护后即刻（T₀）和T₅时点，检测两组患儿应激反应指标和炎症因子水平。比较两组患儿不良反应发生情况。结果 两组患儿手术时间、拔管时间、苏醒时间和麻醉恢复室（PACU）停留时间比较，差异均无统计学意义（P > 0.05）。观察组T₁、T₂、T₃、T₄和T₅时点FLACC和PAED评分明显低于对照组，差异均有统计学意义（P < 0.05）。两组患儿T₅时点血清皮质醇（Cor）、血管紧张素Ⅱ（AngⅡ）、TNF-α和IL-1β水平高于T₀时点，差异均有统计学意义（P < 0.05）；T₅时点，观察组血清Cor、AngⅡ、TNF-α和IL-1β水平明显低于对照组，差异均有统计学意义（P < 0.05）。观察组不良反应发生率明显低于对照组，差异有统计学意义（8.16%和24.49%，P < 0.05）。结论 将艾司氯胺酮应用于儿童TE联合ETA，可发挥良好的镇痛镇静作用，能有效地减轻患儿因手术创伤引起的应激反应和炎症反应。

Abstract:

Objective To investigate the effect of esketamine on postoperative analgesia, stress response and serum tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) levels in children undergoing tonsillectomy (TE) combined with endoscopic-assisted transoral adenoidectomy (ETA).Methods 98 children with tonsil and adenoid hypertrophy from January 2023 to August 2023. They were divided into two groups randomly, with 49 cases in each group. Children in both groups received the same TE plus ETA treatment, and were given the same anesthesia induction and maintenance. The observation group was given 0.5 mg/kg of esketamine injection intravenously 20 min before the operation ended, while the control group same dose of normal saline intravenously. The operation and anesthesia recovery were observed in the two groups. The scores of the face, legs, activity, cry, consolability behavioral tool (FLACC) and pediatric anesthesia emergence delirium scale (PAED) were compared between the two groups immediately after extubation (T₁), 10 min after extubation (T₂), 20 min after extubation (T₃), 30 min after extubation (T₄) and 60 min after extubation (T₅). The stress response indicators and inflammatory reaction mediators were tested at the time entering the operating room (T₀) and T₅ time points. And the two groups were also compared in terms of adverse reactions.Results There were no significant differences in surgical duration, extubation time, wake-up time and length of postanesthesia care unit (PACU) stay between the two groups (P > 0.05). The FLACC and PAED scores at T₁, T₂, T₃, T₄ and T₅ time points in observation group were lower than those of the control group, the differences were statistically significant (P < 0.05). The serum cortisol (Cor), angiotensin Ⅱ (AngⅡ), tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) levels of the two groups at T₅ time point were higher than those at T₀ time point, the differences were statistically significant (P < 0.05). At T₅ time point, the levels of serum Cor, AngⅡ, TNF-α and IL-1β in observation group were lower than those of the control group, the differences were statistically significant (P < 0.05). The incidence of adverse reactions in observation group was significantly lower than that in control group, the difference was statistically significant (8.16% and 24.49%, P < 0.05).Conclusion Application of esketamine in the operation of TE combined with ETA in children can achieve exert good sedative and analgesic outcomes, and effectively reduce the stress response and inflammatory reaction caused by surgical trauma in children.