艾司氯胺酮对小儿四肢骨折术后辅助镇痛效果及预测模型构建

打开文本图片集

中图分类号：R614，R726.8 文献标志码：A DOI：10.11958/20250512

Abstract： Objective To investigate the effect of low-dose esketamine on postoperative analgesia in children with limb fractures and to construct a prediction model. Methods A total of 215 children with limb fractures were selected. After surgery， patients received self-controlled intravenous analgesia （PCIA） with a combination of esketamine and sufentanil. According to the analgesic effect， patients were divided into the good effect group （154 cases） and the poor effect group （61 cases）. Logistic regression analysis was used to identify the factors influencing the analgesic effect of esketamine on postoperative analgesia in children with limb fractures. A nomogram was created to evaluate the prediction model. Results Logistic regression identified the following independent risk factors for poor analgesic effect of esketamine： American Society of Anesthesiologists （ASA） classification of level II （OR=2.731， 95%CI： 1.207-6.180）， lower limb fractures （OR=2.990， 95%CI： 1.474-6.063）， emergency surgery （OR=2.726， 95%CI： 1.284-5.789） and long operation time （OR=1.059， 95%CI： 1.032-1.088）. Independent protective factors included preoperative analgesia （OR=0.338， 95%CI： 0.156-0.731） and postoperative ice application （OR=0.761， 95%CI： 0.658-0.879）. The prediction model for the analgesic effect was： logit（P）=-8.140+1.005×ASA classification + 1.095 × fracture site + 1.003× surgical type - 1.086× preoperative analgesia - 0.274× postoperative ice application +0.057× operation time. In the nomogram， ASA classification II， lower limb fractures， emergency surgery， no preoperative analgesia and no postoperative ice application were assigned 20， 22.5， 20 and 20 points， respectively. For every 10-minute increase in surgery time， the nomogram score increased by 11.5 points. The area under the curve （AUC） for the nomogram model in predicting the analgesic effect of esketamine was 0.827 （95%CI： 0.741-0.852）， with a Brier score of 0.146 and a calibration slope of 0.601， indicating good calibration （Hosmer-Lemeshow χ2=2.271 ， P=0.972 ）. Conclusion Esketamine provides effective postoperative analgesia for children with limb fractures. The constructed nomogram model demonstrates high discrimination and calibration in predicting the analgesic effect in children.

Key words： ketamine; child; extremities; fractures; analgesia; forecasting model

小儿四肢骨折经手术治疗后可使骨折部位得到良好的固定，但术后会出现明显的疼痛感，常出现应激反应，严重影响患儿康复效果［1-2］。（剩余10730字）