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Article(id=1321169685731726021, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1321169668631548508, articleNumber=null, orderNo=null, doi=10.11847/zgggws1145806, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1724860800000, receivedDateStr=2024-08-29, revisedDate=1743696000000, revisedDateStr=2025-04-04, acceptedDate=1755532800000, acceptedDateStr=2025-08-19, onlineDate=1792920999223, onlineDateStr=2026-10-25, pubDate=1757433600000, pubDateStr=2025-09-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792920999223, onlineIssueDateStr=2026-10-25, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792920999223, creator=13701087609, updateTime=1792920999223, updator=13701087609, issue=Issue{id=1321169668631548508, tenantId=1146029695717560320, journalId=1319373219989389464, year='2025', volume='41', issue='9', pageStart='1025', pageEnd='1152', issueExtLink='null', onlineDate='null', pubDate='1757433600000', pubDateStr='2025-09-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792920995147, creator='13701087609', updateTime=1792920995147, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1138, endPage=1141, ext={EN=ArticleExt(id=1321169686000161478, articleId=1321169685731726021, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=Pharmacoepidemiologic evaluation of Esketamine in surgery for children: based on data of 1 296 children undergoing surgery, columnId=1320427686514770171, journalTitle=Chinese Journal of Public Health, columnName=Survey and Report, runingTitle=null, highlight=null, articleAbstract=
Objective

To evaluate the clinical value of intravenous anesthesia with Esketamine in children undergoing surgery.

Methods

A total of 1 296 children undergoing surgery between January 1, 2020 and January 1, 2024 were selected by convenient sampling from two tertiary hospitals in Jinan, China. Participants were allocated into three groups: Esketamine (E) group (n = 447), Propofol (P) group (n = 411), and Sevoflurane (S) group (n = 438). Baseline characteristics, anesthetic efficacy (including anesthesia induction time, emergence time, emergence agitation, duration of emergence agitation, and crying), and adverse reactions were compared among groups.

Results

The three groups were well-balanced in baseline characteristics, with mean age of (6.9 ± 2.8) years and mean body weight of (21.35 ± 8.24) kg. Significant differences were observed in anesthesia induction time [(45.73 ± 9.59) s, (50.36 ± 10.28) s, and (35.53 ± 8.76) s in E, P, and S groups respectively; F = 114.05, P < 0.001] and emergence time [(21.27 ± 4.63) min, (25.34 ± 5.18) min, and (15.42 ± 4.85) min; F = 134.65, P < 0.001]. The incidences of emergence agitation (χ2 = 10.09) and crying (χ2 = 13.42) showed differences among groups (P < 0.05). Regarding safety profiles, significant intergroup differences were observed in incidences of hypotension (χ2 = 15.85), excessive sedation (χ2 = 12.65), respiratory depression (χ2 = 19.83), and pain (χ2 = 9.83) (all P < 0.05).

Conclusions

Esketamine induces effective anesthesia with mild adverse effects in children undergoing surgery.

, authors=Meijing WANG1, Lufeng XU1, Xujian WANG2, authorsList=Meijing WANG, Lufeng XU, Xujian WANG, authorCompany=null, correspAuthors=Xujian WANG, authorNote=null, correspAuthorsNote=
WANG Xujian, E-mail:
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目的

评价儿童手术患者中艾司氯胺酮静脉麻醉的临床效果。

方法

采用便利抽样法选取济南市2家三级医院2020年1月1日至2024年1月1日接受手术治疗的1 296例患儿，其中艾司氯胺酮（Esketamine, E）组447例、丙泊酚（Propofol, P）组411例、七氟醚（Sevoflurane, S）组438例，比较3组患儿基本信息、麻醉疗效（麻醉诱导时间、苏醒时间、苏醒期躁动、苏醒期躁动持续时间、哭闹）及不良反应的差异。

结果

3组患儿基本特征均衡，平均年龄（6.9±2.8）岁，平均体重（21.35±8.24） kg；艾司氯胺酮组、丙泊酚组、七氟醚组麻醉诱导时间分别为（45.73±9.59）、（50.36±10.28）、（35.53±8.76） s，差异有统计学意义（F=114.05， P<0.001）；苏醒时间分别为（21.27±4.63）、（25.34±5.18）、（15.42±4.85） min，差异有统计学意义（F=134.65，P<0.001）；苏醒期躁动发生、哭闹发生情况差异均具有统计学意义（χ2=10.09，13.42， P<0.05）；安全性方面，3组患儿的低血压（χ2=15.85）、过度镇静（χ2=12.65）、呼吸抑制（χ2=19.83）、疼痛（χ2=9.83）发生情况差异均具有统计学意义（P<0.05）。

结论

艾司氯胺酮可为儿童手术患者提供良好的麻醉效果，不良反应较少。

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王梅静（1974—），本科，主任医师，研究方向：麻醉用药的合理性评价

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王绪健，Email：
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Frontiers in Pharmacology, 2022, 13: 1036509., articleTitle=null, refAbstract=null), Reference(id=1321169694111945472, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169685731726021, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=12, rfOrder=11, authorNames=null, journalName=null, refType=null, unstructuredReference=Zhong Y, Jiang M, Wang Y S, et al. Evaluating efficacy and safety of sub-anesthetic dose esketamine as an adjuvant to propofol/remifentanil analgosedation and spontaneous respiration for children flexible fibreoptic bronchoscopy: a prospective, double-blinded, randomized, and placebo-controlled clinical trial[J]. Frontiers in Pharmacology, 2023, 14: 1184663., articleTitle=null, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1321169687468167888, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169685731726021, xref=1, ext=[AuthorCompanyExt(id=1321169687476556497, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169685731726021, companyId=1321169687468167888, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Department of Anesthesiology, Jinan Third People’s Hospital, Jinan 250132, China), AuthorCompanyExt(id=1321169687493333714, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169685731726021, companyId=1321169687468167888, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1济南市第三人民医院麻醉科，济南 250132)]), AuthorCompany(id=1321169689091363539, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169685731726021, xref=2, ext=[AuthorCompanyExt(id=1321169689099752148, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169685731726021, companyId=1321169689091363539, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2Department of Anesthesiology, Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan 250014, China), AuthorCompanyExt(id=1321169689108140757, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169685731726021, companyId=1321169689091363539, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2青岛大学附属山东省妇幼保健院麻醉科，济南 250014)])], figs=[ArticleFig(id=1321169691075269359, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169685731726021, language=EN, label=Tab.1, caption=

General information of children in three groups

, figureFileSmall=null, figureFileBig=null, tableContent=
项目艾司氯胺酮组（N=447）丙泊酚组（N=411）七氟醚组（N=438）
男/女例数201/246186/225222/216
年龄/岁7.4±1.96.0±3.46.3±2.6
体质量/kg20.7±7.319.4±6.223.1±7.8
ASA分级/（例，Ⅰ ∕ Ⅱ）282/165254/157270/168
), ArticleFig(id=1321169691163349744, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169685731726021, language=CN, label=表1, caption=

3组患儿基本情况比较

, figureFileSmall=null, figureFileBig=null, tableContent=
项目艾司氯胺酮组（N=447）丙泊酚组（N=411）七氟醚组（N=438）
男/女例数201/246186/225222/216
年龄/岁7.4±1.96.0±3.46.3±2.6
体质量/kg20.7±7.319.4±6.223.1±7.8
ASA分级/（例，Ⅰ ∕ Ⅱ）282/165254/157270/168
), ArticleFig(id=1321169691243041521, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169685731726021, language=EN, label=Tab.2, caption=

Anesthetic effects on children in three groups

, figureFileSmall=null, figureFileBig=null, tableContent=
指标艾司氯胺酮组（N=447）丙泊酚组（N=441）七氟醚组（N=438）
麻醉诱导时间/（s，$ \overline{x} $±s）45.73±9.5950.36±10.2835.53±8.76
苏醒时间/（min，$ \overline{x} $±s）21.27±4.6325.34±5.1815.42±4.85
苏醒期躁动发生情况/（n，%）30/6.7154/13.1442/9.59
苏醒期躁动持续时间/（min，$ \overline{x} $±s）12.48±3.6514.81±4.7615.52±4.78
哭闹发生情况 /（n，%）120/26.85138/33.58168/38.36
), ArticleFig(id=1321169691326927602, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169685731726021, language=CN, label=表2, caption=

3组患儿麻醉效果比较

, figureFileSmall=null, figureFileBig=null, tableContent=
指标艾司氯胺酮组（N=447）丙泊酚组（N=441）七氟醚组（N=438）
麻醉诱导时间/（s，$ \overline{x} $±s）45.73±9.5950.36±10.2835.53±8.76
苏醒时间/（min，$ \overline{x} $±s）21.27±4.6325.34±5.1815.42±4.85
苏醒期躁动发生情况/（n，%）30/6.7154/13.1442/9.59
苏醒期躁动持续时间/（min，$ \overline{x} $±s）12.48±3.6514.81±4.7615.52±4.78
哭闹发生情况 /（n，%）120/26.85138/33.58168/38.36
), ArticleFig(id=1321169691406619379, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169685731726021, language=EN, label=Tab.3, caption=

Comparison of incidences of adverse reactions of anesthesia in children among three groups

, figureFileSmall=null, figureFileBig=null, tableContent=
不良反应艾司氯胺酮组（N=447）丙泊酚组（N=441）七氟醚组（N=438）χ2值P值
例数占比/%例数占比/%例数占比/%
恶心214.70276.57368.224.530.11
呕吐163.58184.38245.481.880.39
心动过缓122.68122.92153.420.430.81
低血压112.46307.30122.7415.850.00
低氧血症184.03245.84184.112.000.37
过度镇静153.36368.76214.7912.650.00
呼吸抑制235.15235.605412.3319.830.00
尿潴留173.80153.65102.281.950.38
疼痛194.25327.79429.599.800.01
), ArticleFig(id=1321169691482116852, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169685731726021, language=CN, label=表3, caption=

3组患儿麻醉不良反应比较

, figureFileSmall=null, figureFileBig=null, tableContent=
不良反应艾司氯胺酮组（N=447）丙泊酚组（N=441）七氟醚组（N=438）χ2值P值
例数占比/%例数占比/%例数占比/%
恶心214.70276.57368.224.530.11
呕吐163.58184.38245.481.880.39
心动过缓122.68122.92153.420.430.81
低血压112.46307.30122.7415.850.00
低氧血症184.03245.84184.112.000.37
过度镇静153.36368.76214.7912.650.00
呼吸抑制235.15235.605412.3319.830.00
尿潴留173.80153.65102.281.950.38
疼痛194.25327.79429.599.800.01
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艾司氯胺酮用于儿童手术患者的药物流行病学评价——基于1 296例数据分析
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王梅静 1 , 徐鲁峰 1 , 王绪健 2, *, *
中国公共卫生 | 调查报告与分析 2025,41(9): 1138-1141
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中国公共卫生 |调查报告与分析 2025 , 41 (9) : 1138 -1141
艾司氯胺酮用于儿童手术患者的药物流行病学评价——基于1 296例数据分析
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王梅静（1974—），本科，主任医师，研究方向：麻醉用药的合理性评价

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王梅静（1974—），本科，主任医师，研究方向：麻醉用药的合理性评价

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王梅静1, 徐鲁峰1, 王绪健2, *, *
作者信息
  • 1济南市第三人民医院麻醉科，济南 250132
  • 2青岛大学附属山东省妇幼保健院麻醉科，济南 250014
通讯作者:
王绪健，Email：
作者简介:

王梅静（1974—），本科，主任医师，研究方向：麻醉用药的合理性评价

Pharmacoepidemiologic evaluation of Esketamine in surgery for children: based on data of 1 296 children undergoing surgery
Meijing WANG1, Lufeng XU1, Xujian WANG2
Affiliations
  • 1Department of Anesthesiology, Jinan Third People’s Hospital, Jinan 250132, China
  • 2Department of Anesthesiology, Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan 250014, China
    • Corresponding Author:
    WANG Xujian, E-mail:
出版时间: 2025-09-10 doi: 10.11847/zgggws1145806
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摘要
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目的

评价儿童手术患者中艾司氯胺酮静脉麻醉的临床效果。

方法

采用便利抽样法选取济南市2家三级医院2020年1月1日至2024年1月1日接受手术治疗的1 296例患儿，其中艾司氯胺酮（Esketamine, E）组447例、丙泊酚（Propofol, P）组411例、七氟醚（Sevoflurane, S）组438例，比较3组患儿基本信息、麻醉疗效（麻醉诱导时间、苏醒时间、苏醒期躁动、苏醒期躁动持续时间、哭闹）及不良反应的差异。

结果

3组患儿基本特征均衡，平均年龄（6.9±2.8）岁，平均体重（21.35±8.24） kg；艾司氯胺酮组、丙泊酚组、七氟醚组麻醉诱导时间分别为（45.73±9.59）、（50.36±10.28）、（35.53±8.76） s，差异有统计学意义（F=114.05， P<0.001）；苏醒时间分别为（21.27±4.63）、（25.34±5.18）、（15.42±4.85） min，差异有统计学意义（F=134.65，P<0.001）；苏醒期躁动发生、哭闹发生情况差异均具有统计学意义（χ2=10.09，13.42， P<0.05）；安全性方面，3组患儿的低血压（χ2=15.85）、过度镇静（χ2=12.65）、呼吸抑制（χ2=19.83）、疼痛（χ2=9.83）发生情况差异均具有统计学意义（P<0.05）。

结论

艾司氯胺酮可为儿童手术患者提供良好的麻醉效果，不良反应较少。

艾司氯胺酮  /  七氟醚  /  丙泊酚  /  小儿手术  /  药物不良反应
Objective

To evaluate the clinical value of intravenous anesthesia with Esketamine in children undergoing surgery.

Methods

A total of 1 296 children undergoing surgery between January 1, 2020 and January 1, 2024 were selected by convenient sampling from two tertiary hospitals in Jinan, China. Participants were allocated into three groups: Esketamine (E) group (n = 447), Propofol (P) group (n = 411), and Sevoflurane (S) group (n = 438). Baseline characteristics, anesthetic efficacy (including anesthesia induction time, emergence time, emergence agitation, duration of emergence agitation, and crying), and adverse reactions were compared among groups.

Results

The three groups were well-balanced in baseline characteristics, with mean age of (6.9 ± 2.8) years and mean body weight of (21.35 ± 8.24) kg. Significant differences were observed in anesthesia induction time [(45.73 ± 9.59) s, (50.36 ± 10.28) s, and (35.53 ± 8.76) s in E, P, and S groups respectively; F = 114.05, P < 0.001] and emergence time [(21.27 ± 4.63) min, (25.34 ± 5.18) min, and (15.42 ± 4.85) min; F = 134.65, P < 0.001]. The incidences of emergence agitation (χ2 = 10.09) and crying (χ2 = 13.42) showed differences among groups (P < 0.05). Regarding safety profiles, significant intergroup differences were observed in incidences of hypotension (χ2 = 15.85), excessive sedation (χ2 = 12.65), respiratory depression (χ2 = 19.83), and pain (χ2 = 9.83) (all P < 0.05).

Conclusions

Esketamine induces effective anesthesia with mild adverse effects in children undergoing surgery.

Esketamine  /  Sevoflurane  /  Propofol  /  pediatric surgery  /  adverse drug reactions
王梅静, 徐鲁峰, 王绪健. 艾司氯胺酮用于儿童手术患者的药物流行病学评价——基于1 296例数据分析. 中国公共卫生, 2025 , 41 (9) : 1138 -1141 . DOI: 10.11847/zgggws1145806
Meijing WANG, Lufeng XU, Xujian WANG. Pharmacoepidemiologic evaluation of Esketamine in surgery for children: based on data of 1 296 children undergoing surgery[J]. Chinese Journal of Public Health, 2025 , 41 (9) : 1138 -1141 . DOI: 10.11847/zgggws1145806
正文
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儿童健康是全球高度关注的重要问题，为保障儿童用药安全，提高儿童医疗质量，国家卫生健康委办公厅印发了《国家卫生健康委办公厅关于进一步加强儿童临床用药管理工作的通知》[1]。麻醉用药一直是儿童用药管理的热点问题，究其原因主要为儿童体质特殊，各项生理机能尚处于发育阶段，且儿童手术的耐受性和配合程度不同于成人，对疼痛、恶心等主观感受不能准确描述，故儿童患者手术治疗的麻醉用药选择至关重要。艾司氯胺酮于2019年11月获得中国国家药品监督管理局批准上市，是新型N–甲基–D–天冬氨酸（NMDA）受体拮抗剂，通过作用于NMDA受体和阿片受体发挥麻醉与镇痛作用；艾司氯胺酮是氯胺酮的右旋异构体，其生物利用度更高、代谢更快，且镇痛作用较强，精神症状较轻[2–5]。为了探索艾司氯胺酮的儿童患者麻醉用药方案，本研究通过开展艾司氯胺酮的药物流行病学分析，比较儿童手术患者常用麻醉药物的疗效，评价艾司氯胺酮的效果，为儿童患者手术时麻醉方式、麻醉用药选择提供参考依据[6–7]。
1　资料与方法
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1.1　资料来源
采用便利抽样法选取2020年1月1日至2024年1月1日山东省济南市某2家三级医院手术1296例患儿，其中男童609例，女童687例。患儿年龄2～10岁，平均（6.9±2.8）岁，体质量10.1～37.4 kg，平均（21.35±8.24）kg ，手术种类包括疝气255例，阑尾炎285例，口腔科279例，骨科249例，泌尿外科228例。患儿纳入标准：①术前明确诊断且符合手术的指征；②美国麻醉医师学会（American Society of Anesthesiologists, ASA）分级：I ～Ⅱ级；③患儿家属签署知情同意书。患儿排除标准：①存在药物过敏史；②近1个月内存在镇痛或镇静药物使用史；③存在严重心、肺、肝、肾功能异常；④存在严重的免疫、神经、血液等系统疾病。
1.2　方法
患儿术前均常规禁食禁水，无术前用药，进入手术室后常规监测血液流变学指标，若无异常则予患儿建立静脉通路，并采用不同麻醉方式。艾司氯胺酮（Esketamine, E）组447例、丙泊酚（Propofol, P） 组411例、七氟醚（Sevoflurane, S）组438例。E组麻醉诱导：静脉注射咪达唑仑0.05～0.1 mg/kg，芬太尼1～3 μg/kg，顺苯磺酸阿曲库铵 0.2～0.3 mg/kg，艾司氯胺酮0.5～1 mg/kg；术中维持：艾司氯胺酮0.3～1 mg/kg、瑞芬太尼0.25～0.50 μg/（kg·min–1）。P组麻醉诱导：静脉注射咪达唑仑0.05～0.1 mg/kg、芬太尼1～3 μg/kg、顺苯磺酸阿曲库铵 0.2～0.3 mg/kg，丙泊酚 2～3 mg/kg；术中维持：丙泊酚 6～9 mg/kg、瑞芬太尼0.25～0.50μg/（kg·min–1）。S组麻醉诱导：静脉注射咪达唑仑0.05～0.1 mg/kg、芬太尼1～3 μg/kg、顺苯磺酸阿曲库铵0.2～0.3 mg/kg，吸入6%～8%七氟醚；术中维持：间断 1%～2% 七氟醚吸入、瑞芬太尼0.25～0.50 μg/（kg·min–1）。所有的麻醉操作均由经统一培训的经验丰富的麻醉医师完成。
1.3　监测指标
记录患儿麻醉诱导时间、苏醒时间及苏醒期躁动出现及其持续时间。不良反应参考指标：低血压，即收缩压降低超过基础值的20%；低氧血症，即SpO2低于95%；过度镇静，即镇静评分Ramsay量表得分>3分；恶心；呕吐；心动过缓，即心率低于70次/min；呼吸抑制，即呼吸频率低于10次/min或SpO2低于92%；尿潴留；疼痛。采用面部表情、腿部、活动度、哭闹、可安慰性量表（Faces, Legs, Activity, Cry, Consolability Scale, FLACC）评估患儿的疼痛程度 [8]，包括面部表情、腿部状态、躯体状态、哭闹情况、依从性5个维度，每个维度赋分0～2分，总分0～10分；FLACC评分>4分时，使用吗啡（0.2 mg/kg）作为补救镇痛措施；术后6 h内，每隔1 h评估一次；术后6～24 h，每隔6 h评估一次。
1.4　统计分析
采用SPSS 16.0统计软件进行数据分析，计量资料以$ \overline{x}\pm $s表示。组间数据比较采用单因素方差分析；方差不齐时，采用Welch近似方差法得出F值。满足方差齐性时的两两比较采用LSD法（最小显著差值法），不满足方差齐性时的两两比较采用Tambane′s T2法；计数资料的比较采用χ2检验或Fisher确切概率法，并采用Bonferroni法校正检验水准；检验水准α=0.05（双侧），方差齐性检验水准α=0.1。
2　结　果
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2.1　患儿基本情况比较（表1）
艾司氯胺酮组、丙泊酚组、七氟醚组3组患儿的性别（χ2=3.63，P=0.16）、年龄（F=1.05，P=0.35）、体质量（F=1.13，P=0.32）、ASA分级构成（χ2ASA分级=0.24，P=0.89）的差异均无统计学意义。
2.2　3组患儿麻醉的有效性比较（表2）
3组患儿麻醉诱导时间（F=114.05，P<0.001）、苏醒时间（F=134.65，P<0.001）、苏醒期躁动发生情况（χ2=10.09，P=0.006）、哭闹发生情况（χ2=13.42，P=0.001）差异均具有统计学意义，苏醒期躁动持续时间（F=1.92，P=0.15）差异无统计学意义。患儿麻醉诱导时间和苏醒时间，七氟醚组<艾司氯胺酮组<丙泊酚组（3组间两两比较，均P<0.001）；苏醒期躁动发生情况，艾司氯胺酮组低于丙泊酚组（P=0.002），艾司氯胺酮组与七氟醚组（P=0.117）、丙泊酚组与七氟醚组（P=0.103）间差异均无统计学意义；哭闹发生情况，艾司氯胺酮组低于七氟醚组（P=0.000）和丙泊酚组（P=0.032），丙泊酚组与七氟醚组（P=0.147）间差异无统计学意义。
2.3　3组患儿麻醉的安全性比较（表3）
3组患儿的低血压、过度镇静、呼吸抑制、疼痛发生率差异具有统计学意义（P<0.05），其余不良反应发生率差异无统计学意义。低血压发生率，艾司氯胺酮组（P=0.001）和七氟醚组（P=0.002）均低于丙泊酚组，艾司氯胺酮组与七氟醚组间差异无统计学意义（P=0.794）；过度镇静发生率，艾司氯胺酮组（P=0.001）和七氟醚组（P=0.027）均低于丙泊酚组，艾司氯胺酮组与七氟醚组间差异无统计学意义（P=0.279）；呼吸抑制发生率，艾司氯胺酮组（P=0.000）和丙泊酚组（P=0.001）均低于七氟醚组，艾司氯胺酮组与丙泊酚组间差异无统计学意义（P=0.770）；疼痛发生率，艾司氯胺酮组低于丙泊酚组（P=0.029）和七氟醚组（P=0.002），丙泊酚组与七氟醚组间差异无统计学意义（P=0.352）。
3　讨　论
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近年来，儿童用药安全问题已成为全球高度关注的重要议题。麻醉合理用药是影响治疗效果的关键因素，儿科手术麻醉用药对患儿手术顺利实施及术后疗效至关重要[9–10]。本研究中患儿年龄为2～10岁，部分患儿无法准确描述术后疼痛，故疼痛评估工具需恰当选择。FLACC量表可综合患儿的表情、动作行为等进行疼痛评估，适用于无法自我量化疼痛程度的患儿，因此,本研究采用FLACC量表评估患儿的疼痛程度。
艾司氯胺酮作为国内新上市的麻醉药物，是传统儿童麻醉常用药物氯胺酮的对映异构体，其与N–甲基–D–天冬氨酸受体和阿片μ受体的亲和力较高，不仅镇痛、镇静效果优于氯胺酮，且不良反应发生率更低[11]。丙泊酚是烷基酸类短效静脉全身麻醉药，作用于γ–氨基丁酸A型受体，通过非特异性酯酶水解代谢，从而降低肝肾代谢负担，维持内环境稳态。七氟醚是一种吸入麻醉药，具有芳香气味，可缓解患儿对静脉注射的恐惧心理，减少麻醉过程中的哭闹和不配合现象，并降低心血管系统不良反应发生率。针对耐受性较差、尚处于发育阶段的患儿，需根据麻醉效果、不良反应等差异合理选择药物[12]。本研究数据分析结果显示，艾司氯胺酮用于儿童麻醉时，苏醒期躁动持续时间与丙泊酚、七氟醚组相当；在麻醉诱导时间、苏醒时间、苏醒期躁动、低血压和过度镇静发生率方面均优于丙泊酚；在哭闹、呼吸抑制和疼痛发生率方面优于七氟醚。基于本研究数据，艾司氯胺酮可推荐作为儿童手术的麻醉用药。综上所述，艾司氯胺酮可为儿童手术患者提供良好的麻醉效果，镇痛作用显著，且不良反应较丙泊酚、七氟醚更少，为儿童手术麻醉用药选择提供参考依据。

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2025年第41卷第9期
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doi: 10.11847/zgggws1145806
  • 接收时间：2024-08-29
  • 首发时间：2026-10-25
  • 出版时间：2025-09-10
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  • 收稿日期：2024-08-29
  • 修回日期：2025-04-04
  • 录用日期：2025-08-19
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    1济南市第三人民医院麻醉科，济南 250132
    2青岛大学附属山东省妇幼保健院麻醉科，济南 250014

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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