目的 探讨艾司氯胺酮复合七氟醚用于日间小儿包皮环扎手术的最佳使用剂量。 方法 将拟行日间包皮环扎手术的小儿根据随机数字表法随机分为A组（艾司氯胺酮0.5 mL/kg组）、B组（艾司氯胺酮0.75 mL/kg组）和C组（艾司氯胺酮1 mL/kg组），每组30例。各组患儿面罩吸入七氟醚诱导，待睫毛反射消失后单次静脉给予相应剂量的艾司氯胺酮。记录患儿术中体动发生和艾司氯胺酮追加次数情况，监测患儿入手术室（T₀）、手术开始时（T₁）、术中套扎时（T₂）及手术结束后1 min（T₃）的心率（HR）、平均动脉压（MAP）、脉氧饱和度（SpO₂）及呼吸频率（RR）；记录麻醉时长、术毕睁眼时间及对话时间，术毕15、30、60 min的改良警觉/镇静评分（MOAA/S评分）；苏醒时、术后2 h、术后6 h的东安大略儿童医院疼痛评分（CHEOPS评分）、Bieri改良面部表情评分、语言等级评定量表（verbal rating scale， VRS）评分以及术中和术后不良反应（呼吸抑制、恶心呕吐、躁动、头晕、复视等）。 结果 B、C两组患儿术中体动及艾司氯胺酮追加次数少于A组（P < 0.05）；A、B两组患儿睁眼时长和可对话时长短于C组（P < 0.05）；3组患儿术中生命体征及术后清醒评分、疼痛评分差异无统计学意义（P > 0.05）；3组患儿不良反应发生率差异无统计学意义（P > 0.05）。 结论 0.75 mg/kg艾司氯胺酮复合七氟醚能有效满足小儿包皮手术的麻醉镇痛需求并缩短术后苏醒时间，是最佳适宜剂量，适合在日间小儿包皮环扎手术中推广应用。

Objective We tried to explore the optimal dose of esketamine combined sevoflurane for the daytime pediatric circumcision. Methods According to the random number table， children who underwent daytime circumcision were randomly divided into Group A （0.5 mL/kg esketamine）， Group B （0.75 mL/kgesketamine）， and Group C （1mL/kg esketamine） with 30 cases in each group. Each group were induced with sevoflurane inhalation anesthesia by mask and given a single intravenous dose of the corresponding esketamine after the eyelash reflex disappeared. The occurrence of intraoperative movement and esketamine bolus times was recorded. Heart rate （HR）， mean arterial pressure （MAP）， pulse oxygen saturation （SpO₂） and respiratory rate （RR） were monitored at the time of entry （T₀）， the beginning of surgery （T₁）， intraoperative ligation （T₂） and the end of surgery （T₃）. The times of opening eyes and talking after surgery were also recorded. Modified Alertness/Sedation Score （MOAA/S score） at 15 min， 30 min and 60 min after surgery， the Eastern Ontario Children's Hospital Pain Score （CHEOPS score）， Bieri Modified Facial expression score and verbal rating scale （VRS） score at the time of awakening， 2 h and 6 h after surgery were all recorded. Moreover， intraoperative and postoperative adverse reactions （respiratory depression， laryngeal spasm， agitation， nausea and vomiting， dizziness and diplopia ect.） were all marked. Results The incidence of intraoperative body movement andesketamine bolus times in Group B and C were all less than that in Group A （P < 0.05）. The time of opening eyes and talking in Group A and Group B were shorter than those in Group C （P < 0.05）. There was no significant difference in intraoperative vital signs， postoperative alertness score and pain score among the 3 groups （P < 0.05）. There was no significant difference in the incidence of adverse reactions among the 3 groups （P < 0.05）. Conclusion A does of 0.75 mg/kg esketamine combined with sevoflurane could effectively meet the anesthetic and analgesic needs of children's prepuce operation and shorten postoperative recovery time. It is the optimal dose and deserving promotion in daytime pediatric circumcision.