艾司氯胺酮超前镇痛对发育性髋关节脱位手术患儿疼痛控制效果分析

doi:10.3760/cma.j.cn441417-20250319-15004

摘要/Abstract

摘要：

目的　探讨艾司氯胺酮超前镇痛对发育性髋关节脱位（DDH）手术患儿的疼痛控制效果及安全性。方法　回顾性选取2021年1月至2023年12月于西安交通大学附属红会医院行DDH手术的120例患儿作为研究对象，按照随机数字表法将患儿分为对照组（60例）和观察组（60例）。观察组中男10例，女50例，年龄（3.25±0.73）岁；对照组中男9例，女51例，年龄（3.17±0.86）岁。手术结束前30 min，观察组静脉注射0.5 mg/kg艾司氯胺酮进行超前镇痛，对照组给予等量生理盐水。比较两组患儿术后2、4、8、12、24 h的儿童疼痛行为评分量表（FLACC）和威斯康星州儿童医院镇静量表（CHW）评分，观察并记录术后不良反应的发生情况。统计学意义采用χ²检验、t检验、重复测量方差分析。结果　术后2、4、8、12、24 h，观察组的FLACC评分分别为（2.75±1.53、2.41±1.22、2.18±1.05、1.76±0.61、1.45±0.42）分，对照组分别为（4.31±1.82、3.75±1.43、3.23±1.21、2.79±1.08、2.18±0.73）分，差异均有统计学意义（均P<0.05）；随着术后时间的推移，两组患儿的FLACC评分呈下降趋势。观察组患儿术后2、4、8、12 h的CHW评分均低于对照组（均P<0.05），而术后24 h差异无统计学意义（P>0.05）；随着时间推移，两组患儿的CHW评分呈上升趋势。两组不良反应总发生率比较［20.0%（12/60）比16.7%（10/60）］，差异无统计学意义（χ²=0.223，P=0.637）。结论　艾司氯胺酮超前镇痛在患儿DDH手术中具有良好的疼痛控制效果，能够显著降低患儿术后疼痛评分，且术后不良反应发生率低。

关键词:

髋关节脱位, 发育性, 艾司氯胺酮, 超前镇痛, 安全性, 儿童

Abstract:

Objective　To investigate the effects and safety of preemptive analgesia with esketamine for pain control in children undergoing surgery for developmental dysplasia of the hip (DDH). Methods　A retrospective study was conducted involving 120 children who underwent DDH surgery at the Xi'an Jiaotong University Affiliated Honghui Hospital from January 2021 to December 2023. The children were randomly divided into a control group (60 cases) and an observation group (60 cases). In the observation group, there were 10 males and 50 females, aged (3.25±0.73) years; in the control group, there were 9 males and 51 females, aged (3.17±0.86) years. The observation group received intravenous injection of 0.5 mg/kg esketamine for preemptive analgesia 30 min before the end of surgery, while the control group received an equivalent volume of saline. Pain levels were assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) scale and the Wisconsin Children's Hospital Sedation Scale (CHW) at postoperative hours 2, 4, 8, 12, and 24. The occurrence of postoperative adverse reactions was observed and recorded. Statistical significance was evaluated using the χ² test, t test, and repeated measures ANOVA. Results　At postoperative hours 2, 4, 8, 12, and 24, the FLACC scores in the observation group were (2.75±1.53, 2.41±1.22, 2.18±1.05, 1.76±0.61, 1.45±0.42) points, while those in the control group were (4.31±1.82, 3.75±1.43, 3.23±1.21, 2.79±1.08, 2.18±0.73) points, with all differences being statistically significant (all P<0.05). Over time, both groups showed a decreasing trend in FLACC scores. The CHW scores for the observation group at postoperative hours 2, 4, 8, and 12 were lower than those in the control group (all P<0.05), while there was no statistically significant difference at 24 hours postoperatively (P>0.05), with CHW scores showing an increasing trend over time. The overall incidence of adverse reactions between the two groups was not significantly different [20.0% (12/60) vs. 16.7% (10/60)] (χ²=0.223, P=0.637). Conclusion　Esketamine preemptive analgesia has good pain control effect in children with DDH surgery, can significantly reduce the postoperative pain scores of children, and has a low incidence of postoperative adverse reactions.

Key words:

Dislocation of hip joint, Developmental, Esketamine, Preemptive analgesia, Safety, Children

黄敬媛蔡亮吕海港邓亚南.

艾司氯胺酮超前镇痛对发育性髋关节脱位手术患儿疼痛控制效果分析 [J]. 国际医药卫生导报, 2025, 31(15): 2482-2486.

Huang Jingyuan, Cai Liang, Lyu Haigang, Deng Yanan.

Analysis of the pain control effect of esketamine preemptive analgesia in children undergoing developmental dysplasia of the hip surgery [J]. International Medicine and Health Guidance News, 2025, 31(15): 2482-2486.

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