Abstract: Objective To investigate the effect of low-dose esketamine combined with sufentanil on patient-controlled intravenous analgesia （PCIA） in children after allergic penile correction surgery. Methods In this study, a total of 90 children aged 4 to 12 years who were scheduled to undergo corrective surgery for concealed penis were selectedand divided equally into SE₀, SE₁ and SE₂ groups. All children received anethesia induction with sufentanil and esketamine, while a sacral block was performed under ultrasound guidance and intraoperative anaesthesia was maintained with 1.3 MAC sevoflurane. The postoperative self-administered intravenous analgesia regimen was： 1 μg/（kg·24 h） of sufentanil in group SE₀, 1 μg/（kg·24 h）of sufentanil + esketamine 0.5 mg/（kg·24 h）in group SE₁ and 1 μg/kg of sufentanil + esketamine 1 mg/kg in group SE₂, all diluted with 0.9% saline to 200 ml. Heart rate, mean arterial pressure, delirium score during anesthesia awakening, Wong-Baker analgesia score, Ramsay sedation score, number of postoperative analgesic pump presses, sufentanil dosage and occurrence of adverse effects were recorded in the three groups of children. Results The SE₁ and SE₂ groups experienced fewer postoperative analgesic pump presses and less sufentanil than the SE₀ group （P<0.0165）. The SE₂ group achieved fewer analgesic pump presses and less sufentanil consumption than the SE₁ group, and had higher Ramsay sedation scores at T₄ than the SE₁ and SE₀ groups （P<0.05）. At remaining moments, there were no significant differences between the groups in terms of delirium scores, analgesia, sedation scores, heart rate, mean arterial pressure and incidence of adverse reactions during the awakening period of paediatricanaesthesia （P>0.05）. Conclusion Low-dose esketamine combined with sufentanil PCIA achieves satisfactory postoperative analgesia in children undergoing hidden penis correction surgery, reduces total sufentanil dosage, and avoids emergence delirium or other significant adverse reactions.

Key words: esketamine, children, concealed penile correction surgery, postoperative patient-controlled intravenous analgesia

摘要： 目的 探讨在隐匿阴茎矫正术后小剂量艾司氯胺酮对儿童舒芬太尼自控静脉镇痛的影响。方法 本研究选取90名拟行隐匿阴茎矫正手术的4~12岁儿童,分为SE₀、SE₁、SE₂组,所有儿童均采用舒芬太尼和艾司氯胺酮进行麻醉诱导,同时在B超引导下行骶管阻滞,术中以1.3 MAC七氟烷维持麻醉。术后自控静脉镇痛方案为：SE₀组给予舒芬太尼1 μg/（kg·24 h）,SE₁组给予舒芬太尼1 μg/（kg·24 h）+艾司氯胺酮0.5 mg/（kg·24 h）,SE₂组给予舒芬太尼1 μg/（kg·24 h）+艾司氯胺酮1 mg/（kg·24 h）,均使用0.9%盐水稀释到200 mL。记录了三组儿童的心率、平均动脉压、麻醉苏醒期谵妄评分、Wong-Baker镇痛评分、Ramsay镇静评分、术后镇痛泵按压次数、舒芬太尼用量以及不良反应发生情况。结果 SE₁和SE₂组的术后镇痛泵按压次数和舒芬太尼用量少于SE₀组（P<0.05）;SE₂组的镇痛泵按压次数和舒芬太尼用量少于SE₁组,并且T₄时刻的Ramsay镇静评分高于SE₁、SE₀组（P<0.05）。在其余时刻,各组儿童麻醉苏醒期谵妄评分、镇痛、镇静评分、心率、平均动脉压以及不良反应发生率之间没有显著差异（P>0.05）。结论 在隐匿阴茎矫正术后,小剂量艾司氯胺酮复合舒芬太尼静脉镇痛可实现满意的术后镇痛效果,同时减少舒芬太尼总量,无苏醒期谵妄等不良反应。

关键词: 艾司氯胺酮, 儿童, 隐匿阴茎矫正术, 术后自控静脉镇痛