2023 年第 2 期 第 18 卷

不同剂量艾司氯胺酮联合丙泊酚用于先天性心脏病患儿介入手术麻醉的效果

Effects of different doses of esketamine combined with propofol on cardiac intervention anesthesia in children with congenital heart disease

作者：刘文君林多茂赵丽云马骏

英文作者：Liu Wenjun Lin Duomao Zhao Liyun Ma Jun

单位：首都医科大学附属北京安贞医院麻醉中心，北京100029

英文单位：Anesthesia Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：

英文关键词：Congenitalheartdisease;Esketamine;Cardiacintervention

• 摘要：

• 目的 观察不同剂量艾司氯胺酮联合丙泊酚用于先天性心脏病（CHD）患儿介入手术麻醉的效果。方法 本研究为前瞻性随机对照试验。选取首都医科大学附属北京安贞医院2020年12月至2021年12月收治的CHD患儿60例，择期行心脏造影介入诊疗术。按照随机数字表法将其分为3组，每组20例。患儿进入导管室后，静脉滴注1%丙泊酚2 mg/kg，同时静脉滴注0.01 mg/kg的阿托品，患儿入睡后，L组予静脉匀速滴注艾司氯胺酮0.4 mg/kg，M组予静脉匀速滴注艾司氯胺酮0.5 mg/kg，H组予静脉匀速滴注艾司氯胺酮0.6 mg/kg，之后持续静脉泵注1%丙泊酚4～6 mg/（kg·h），鼻导管进行吸氧（3 L/min）。记录患儿性别、年龄、体质量、手术时间、麻醉维持时间、术中追加丙泊酚次数、苏醒时间。记录患儿给药前(T0) 、给药后入睡时(T1) 、穿刺时(T2) 、苏醒时(T3)的心率、平均动脉压（MAP）和指尖脉搏血氧饱和度（SpO2）。结果 3组性别、年龄、体质量、手术时间、麻醉维持时间比较差异均无统计学意义（均P＞0.05）。H组苏醒时间长于L组，术中追加丙泊酚次数少于L组和M组［1.0（0,1.0）次比2.0（1.0,2.5）、1.0（1.0,2.0）次］，差异均有统计学意义（均P＜0.05）。L组、M组T1~T3时点心率、SpO2均高于本组T0时点，H组T1、T2时点心率、T1~T3时点SpO2均高于本组T0时点，差异均有统计学意义（均P＜0.05）。3组各时点MAP比较差异均无统计学意义（均P＞0.05），且都在临床正常范围内。T3时点L组、M组、H组SpO2呈降低趋势［（99.8±0.4）%、（98.8±1.4）%、（98.6±0.4）%］（P＜0.05）。结论 在CHD患儿介入手术中，0.6 mg/kg艾司氯胺酮复合丙泊酚静脉麻醉安全有效。

• Objective To observe the effects of different doses of esketamine combined with propofol on cardiac intervention anesthesia in children with congenital heart disease (CHD). Methods  This was a randomized, controlled, and prospective trial. Totally 60 children with CHD undergoing elective cardiac intervention were selected in Beijing Anzhen Hospital, Capital Medical University from December 2020 to December 2021. They were divided into three groups according to the random number table method, with 20 cases in each group. After children entered the catheterization room, 1% propofol 2 mg/kg was injected intravenously, and 0.01 mg/kg of atropine was injected intravenously at the same time. After falling asleep, group L was injected with esketamine 0.4 mg/kg intravenously at a uniform rate, group M was injected with esketamine 0.5 mg/kg intravenously at a uniform rate, and group H was injected with esketamine 0.6 mg/kg intravenously at a uniform rate, followed by continuous intravenously pumping of 1% propofol 4-6 mg/（kg·h）. The oxygen was administered by nasal cannula (3 L/min). The gender, age, body mass, operation time, duration of anesthesia, times of additional propofol during operation, and awakening time were recorded. The heart rate, mean arterial pressure (MAP) and pulse oxygen saturation (SpO2) were recorded before administration (T0), falling asleep after administration (T1), at the time of puncture (T2) and at the time of awakening (T3). Results  There were no statistically significant differences in gender, age, body mass, operation time, duration of anesthesia among the three groups (all P>0.05). The awakening time in group H was longer than that in group L, and times of additional propofol during operation in group H were fewer than those in group L and group M ［1.0（0,1.0）times vs 2.0（1.0,2.5）, 1.0（1.0,2.0）times］(all P<0.05). The heart rate and SpO2 in group L and group M at T1-T3 were higher than those at T0 within each group; in group H, the heart rate at T1 and T2, and SpO2 at T1-T3 were higher than those at T0 (all P<0.05). There were no statistically significant differences in MAP among the three groups at each time point (all P>0.05), and those were all within the clinically normal range. At T3, SpO2 showed a decreasing trend in group L, group M and group H［（99.8±0.4）%,（98.8±1.4）%,（98.6±0.4）%］(P＜0.05). Conclusion  Esketamine 0.6 mg/kg combined with propofol for anesthesia is safe and effective in cardiac intervention in children with CHD.