瑞马唑仑联合艾司氯胺酮在小儿扁桃体加腺样体切除术中的应用

钱威; 张从利; 张运淳

doi:10.16766/j.cnki.issn.1674-4152.004331

瑞马唑仑联合艾司氯胺酮在小儿扁桃体加腺样体切除术中的应用

doi: 10.16766/j.cnki.issn.1674-4152.004331

蚌埠医科大学第一附属医院麻醉科，安徽蚌埠 233004

基金项目:

安徽省高校自然科学重点项目 KJ2020A0581

详细信息

通讯作者:
张运淳，E-mail: mzycz@126.com

中图分类号: R614
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- 被引次数: 0
出版历程
- 收稿日期: 2025-01-30
- 网络出版日期: 2026-04-01

Application of Remazolam combined with Esketamine in tonsillar-adenoidectomy in children

Department of Anesthesiology, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨瑞马唑仑联合艾司氯胺酮用于小儿扁桃体加腺样体切除术对患者术中血流动力学、应激反应及术后苏醒质量的影响。方法选取2023年1—12月于蚌埠医科大学第一附属医院全麻下行扁桃体加腺样体切除术患儿60例作为研究对象，按随机数字表法分为观察组(R组)和对照组(B组)，每组30例。观察组使用瑞马唑仑诱导与维持麻醉，对照组使用丙泊酚诱导与维持麻醉，比较2组诱导前(T0)、诱导完毕时(T1)、插管时(T2)、手术开始时(T3)、手术开始后10 min(T4)以及气管插管拔出时(T5)的血流动力学和血液应激性指标变化，比较2组术后15 min(T6)、术后30 min(T7)的躁动评分和镇痛评分，比较2组拔管时间、麻醉复苏室(PACU)停留时间及术后不良反应发生率。结果 R组于T1~T5时刻，血压与心率变化幅度低于B组，差异有统计学意义(P＜0.05)。R组T4时，血清皮质醇(Cor)、去甲肾上腺素(NE)及葡萄糖(Glu)等应激指标低于B组，差异有统计学意义(P＜0.05)。R组于T6、T7时躁动评分低于B组，差异有统计学意义(P＜0.05)。R组拔管时间(8.90±1.18)min与PACU停留时间(30.50±2.26)min均少于B组[(9.83±1.34)min、(34.47±1.93)min，P＜0.05]。结论瑞马唑仑与艾司氯胺酮联合用于小儿扁桃体加腺样体切除术，术中血流动力学变化更加平稳，减少术中应激反应，提高苏醒质量。
- 瑞马唑仑 /
- 艾司氯胺酮 /
- 小儿麻醉 /
- 扁桃体肥大 /
- 腺样体肥大
Abstract: Objective To investigate the effects of remazolam in combination with esketamine on intraoperative haemodynamics, stress response, and postoperative quality of awakening in paediatric tonsillectomy and adenoidectomy. Methods In this study, 60 paediatric patients who underwent tonsillectomy and adenoidectomy under general anaesthesia at the First Affiliated Hospital of Bengbu Medical University between January 2023 and December 2023 were selected for the study and randomly divided into two groups: an observation group (Group R) and a control group (Group B), each with 30 patients. In the observation group, remazolam was used for induction and maintenance of anaesthesia; in the control group, propofol was used for induction and maintenance of anaesthesia. The changes in haemodynamic and blood pressure indices were compared between the two groups before induction (T0), during completion of induction (T1), during intubation (T2), during the start of surgery (T3), during removal of the tracheal intubation 10 minutes after the start of surgery (T4) and during withdrawal of the tracheal intubation (T5) as well as at the time of postoperative 15. The changes in haemodynamic and blood pressure indicators, agitation score, and analgesia score 15 minutes (T6) and 30 minutes (T7) postoperatively, the time to extubation, the length of stay in the recovery room (PACU), and the occurrence of adverse reactions during the recovery phase in the two groups were compared. Results In group R, blood pressure and heart rate changes at T1-T5 were lower than those in group B, and the difference was statistically significant (P < 0.05). In group R, cortisol (Cor), norepinephrine(NE), and glucose(Glu) were lower in T4 compared to group B. The difference was statistically significant (P < 0.05). The awakening scores of group R at T6 and T7 were lower than those of group B, and the difference was statistically significant (P < 0.05). Extubation time (8.90±1.18) min and PACU length of stay (30.50±2.26) min in group R were shorter than (9.83±1.34) min and (34.47±1.93) min in group B, and the difference was statistically significant (P < 0.05). Conclusion The combination of remazolam and esketamine in paediatric tonsillectomy and adenoidectomy can soften the perioperative haemodynamic changes, reduce the intraoperative stress response, and improve the quality of children' s awakening during the recovery period.
- Remazolam /
- Esketamine /
- Pediatric anesthesia /
- Hypertrophy of the tonsil /
- Adenoidal hypertrophy

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表 1 2组患儿一般资料比较

Table 1. Comparison of general data of the two groups of children

组别	例数	性别(例)		年龄(x±s，岁)	ASA分级(例)		BMI (x±s)	病程(x±s，月)
组别	例数	男	女	年龄(x±s，岁)	Ⅰ级	Ⅱ级	BMI (x±s)	病程(x±s，月)
R组	30	17	13	6.13±1.83	19	11	21.50±1.33	8.48±3.15
B组	30	14	16	5.93±1.82	20	10	20.98±1.25	8.72±3.24
统计量		0.060^a		0.424^b	0.073^a		1.561^b	0.291^b
P值		0.438		0.673	0.787		0.124	0.772
注：^a为χ²值，^b为t值。

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表 2 2组患儿各时间点血流动力学指标比较(x±s)

Table 2. Comparison of hemodynamic indices at each time point between the two groups of children(x±s)

组别	例数	MAP(mmHg)
组别	例数	T0	T1	T2	T3	T4	T5
R组	30	78.42±8.36	68.43±7.24^a	68.53±8.06^a	69.26±6.05^a	70.38±7.88^a	72.42±6.01^a
B组	30	77.56±8.72	60.43±7.07^a	63.11±7.96^a	65.39±6.82^a	66.44±7.12^a	68.56±7.26^a
F值		0.152	18.750	6.868	5.406	4.129	5.032
P值		0.698	＜0.001	0.011	0.024	0.047	0.029

组别	例数	HR(次/min)
组别	例数	T0	T1	T2	T3	T4	T5
R组	30	99.32±5.48	96.35±4.59^a	102.48±4.04^a	102.14±4.18^a	102.57±3.97^a	105.26±4.87^a
B组	30	98.67±6.34	92.12±4.36^a	105.52±5.57^a	106.27±4.78^a	105.38±4.22^a	110.49±5.24^a
F值		0.180	13.394	5.856	12.691	7.057	16.035
P值		0.673	0.001	0.019	0.001	0.010	＜0.001
注：与同组T0时比较，^aP＜0.05；1 mmHg=0.133 kPa。

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表 3 2组患儿各时间点应激指标比较(x±s)

Table 3. Comparison of stress indicators at each time point between the two groups of children(x±s)

组别	例数	Cor(ng/mL)		NE(pg/mL)		Glu(mmol/L)
组别	例数	T0	T4	T0	T4	T0	T4
R组	30	243.23±24.76	254.22±27.63^a	280.07±13.18	290.77±13.67^a	4.92±0.69	5.24±0.73^a
B组	30	245.13±23.30	269.32±27.12^a	284.60±12.78	306.73±17.07^a	4.96±0.64	5.84±0.88^a
统计量		0.306^b	4.564^c	1.352^b	15.908^c	0.233^b	8.261^c
P值		0.761	0.037	0.182	＜0.001	0.817	0.006
注：与同组T0时比较，^aP＜0.05；^b为t值，^c为F值。

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表 4 2组患儿术后镇静镇痛效果比较(x±s，分)

Table 4. Comparison of postoperative sedation and analgesia effects between the two groups of children(x±s, points)

组别	例数	PAED		FLACC
组别	例数	T6	T7	T6	T7
R组	30	3.00±0.53	2.23±0.43^a	2.80±0.61	2.06±0.37^a
B组	30	3.57±0.82	3.13±0.63^a	2.90±0.48	2.26±0.43^a
统计量		3.200^b	41.767^c	0.706^b	3.729^c
P值		0.478	＜0.001	0.483	0.058
注：与同组T6时比较，^aP＜0.05；^b为t值，^c为F值。

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表 5 2组患儿手术时间、拔管时间及PACU停留时间比较(x±s，min)

Table 5. Comparison of operation time, extubation time and PACU stay between the two groups(x±s, min)

组别	例数	手术时间	拔管时间	PACU停留时间
R组	30	38.43±3.70	8.90±1.18	30.50±2.26
B组	30	39.20±4.60	9.83±1.34	34.47±1.93
t值		0.714	2.853	7.317
P值		0.478	0.006	＜0.001

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