标题：艾司氯胺酮在超声引导下经皮封堵治疗先心病麻醉中的应用

      作者：李砚，任苏恩，钟巍    河南省胸科医院及郑州大学附属胸科医院麻醉科，河南 郑州 450000

      卷次： 2024年35卷12期

      【摘要】 目的 探讨艾司氯胺酮在超声引导下经皮封堵治疗先心病麻醉中的应用效果。方法 选择2020年3月至2022年1月于河南省胸科医院接受超声引导下经皮封堵治疗的100例先心病患儿进行研究，根据随机数表法分为对照组和观察组各50例。对照组患儿在麻醉中采用瑞芬太尼，观察组在麻醉中采用艾司氯胺酮。比较两组患儿术前及术后1 d的血流动力学[收缩期速度峰值(PSV)、舒张末期血流速度(EDV)、阻力指数(RI)及血流量]；术后1 d，记录两组患儿的麻醉效果(苏醒时间、拔管时间、ICU停留时间)；术后10 min，采用Malviya评分法及Ramsay评分法评估躁动及镇静程度，并记录麻醉过程中的不良反应发生情况。结果 观察组患儿术后1 d的PSV、EDV、血流量水平分别为(50.17±5.08) cm/s、(9.52±1.16) cm/s、(38.23±7.36) mL/min，明显高于对照组的(43.69±4.94) cm/s、(9.00±1.08) cm/s、(33.80±7.11) mL/min，RI水平为0.67±0.09，明显低于对照组的0.80±0.12，差异均有统计学意义(P<0.05)；观察组患儿的苏醒时间、拔管时间、ICU停留时间分别为(13.37±2.34) min、(14.05±1.84) min、(16.56±1.87) h，明显短于对照组的(16.48±2.79) min、(17.78±2.43) min、(22.36±2.40) h，差异均有统计学意义(P<0.05)；观察组患儿的Malviya评分为(1.50±0.13)分，明显低于对照组的(2.33±0.21)分，Ramsay镇静评分为(4.21±0.45)分，明显高于对照组的(3.13±0.40)分，差异均有统计学意义(P<0.05)；在住院期间，观察组患儿的呛咳、恶心、呕吐的总发生率为6.00%，明显低于对照组的20.00%，差异有统计学意义(P<0.05)。结论 艾司氯胺酮在超声引导下经皮封堵治疗先心病麻醉中的效果明显，其能降低术后躁动，改善血流动力学指标水平。
      【关键词】 先天性心脏病；艾司氯胺酮；经皮封堵治疗；麻醉效果；血流动力学
      【中图分类号】 R541.1 【文献标识码】 A 【文章编号】 1003—6350（2024）12—1723—04

Application of esketamine in ultrasound-guided percutaneous closure for anesthesia of congenital heart disease.LI Yan, REN Su-en, ZHONG Wei.
Department of Anesthesiology, Henan Provincial Chest Hospital, Chest Hospital ofZhengzhou University, Zhengzhou 450000, Henan, CHINA
【Abstract】 Objective To study the application of esketamine in ultrasound-guided percutaneous closure for an-esthesia of congenital heart disease. Methods A total of 100 children with congenital heart disease undergoing ultra-sound-guided percutaneous closure in Henan Provincial Chest hospital from March 2020 to January 2022 were selectedfor the study. The patients were divided into a control group and an observation group according to random number tablemethod, with 50 patients in each group. Remifentanil was used in the control group, and esketamine was used in the ob-servation group. The hemodynamics [peak systolic velocity (PSV), end diastolic velocity (EDV), resistance index (RI),and blood flow] of two groups of children before and 1 day after surgery were compared. The anesthesia effect (awaken-ing time, extubation time, length of ICU stay) of the two groups of children were recorded on the 1st day after surgery. At10 minutes after surgery, the level of agitation and sedation were evaluated using the Malviya and Ramsay scoring meth-ods, and the occurrence of adverse reactions during the anesthesia process were recorded. Results The PSV, EDV, andblood flow levels in the observation group on the 1st day after surgery were (50.17±5.08) cm/s, (9.52±1.16) cm/s, and(38.23±7.36) mL/min, which were significantly higher than (43.69±4.94) cm/s, (9.00±1.08) cm/s, and (33.80±7.11) mL/min of the control group; RI level was 0.67±0.09, which was significantly lower than 0.80±0.12 of the controlgroup; the differences were statistically significant (P<0.05). The recovery time, extubation time, and length of ICU stayof the observation group were (13.37±2.34) min, (14.05±1.84) min, and (16.56±1.87) h, which were significantly shorterthan (16.48±2.79) min, (17.78±2.43) min, (22.36±2.40) h in the control group (P<0.05). Malviya score of the observa-tion group was (1.50±0.13) points, which was significantly lower than (2.33±0.21) points of the control group; Ramsaysedation score was (4.21±0.45) points, which was significantly higher than (3.13±0.40) points of the control group; thedifferences were statistically significant (P<0.05). During hospitalization, the total incidence of cough, nausea, andvomiting in the observation group was 6.00%, which was significantly lower than 20.00% in the control group (P<0.05). Conclusion Esketamine has obvious effect in ultrasound-guided percutaneous closure for anesthesia of congeni-tal heart disease, which can reduce postoperative agitation and improve hemodynamic index level.
      【Key words】 Congenital heart disease; Esketamine; Percutaneous closure; Anesthetic effect; Hemodynamics