超声引导下横筋膜平面阻滞在儿童腹股沟疝手术的应用效果

The application effect of ultrasound-guided transverse fascial plane block in pediatric inguinal hernia surgery

目的分析超声引导下横筋膜平面阻滞在儿童腹股沟疝手术的应用效果。方法选取2019年1月至2022年9月,阜南县人民医院拟接受腹腔镜腹股沟疝修补术治疗的100例腹股沟疝患儿,经随机数字表法分为对照组(n=50)、观察组(n=50)。对照组接受全身麻醉,观察组接受超声引导下横筋膜平面阻滞联合全身麻醉。检测并对比2组入室时(T1)、首次麻醉完成后5 min(T2)、切皮时(T3)及手术结束时(T4)各时点的心率、平均动脉压(MAP)等血流动力学指标;使用视觉模拟评分法(VAS)评估2组麻醉苏醒后6 h(T5)、12 h(T6)、24 h(T7)、48 h(T8)的镇痛情况;记录2组手术时间、术后恢复活动时间和住院时间;2组住院期间的不良反应发生情况。结果T2~T4时,2组的心率、MAP均较T1时降低,但在T4时回升,且观察组T2~T4时心率、MAP均高于对照组,各指标组别、时点、组别时点交互比较,差异有统计学意义(P<0.05)。经广义估计方程分析显示,VAS评分通过对截距项(P<0.001)、组别(P<0.001)、时点(P<0.001)及组别时点交互比较,差异有统计学意义(P<0.001)。固定效应的显著性检验显示,在T7、T8时点的VAS评分,观察组低于对照组,差异有统计学意义。2组的手术时间差异无统计学意义(P>0.05);观察组术后恢复活动时间(6.63±0.31)h和住院时间(3.09±0.31)d均短于对照组(7.97±0.49)h、(5.47±0.47)d,差异有统计学意义(P<0.05);2组头痛、瘙痒发生率差异无统计学意义(P>0.05);观察组恶心、呕吐发生率(2.00%)低于对照组(16.00%),差异有统计学意义(P<0.05)。结论超声引导下横筋膜平面阻滞联合全身麻醉在腹股沟疝手术儿童中的应用价值高,术后镇痛效果好,且更利于患儿术后恢复,降低不良反应发生风险,安全性好。

Objective To analyze the application effect of ultrasound-guided transverse fascial plane block in pediatric inguinal hernia surgery.Methods From January 2019 to September 2022,100 children with inguinal hernia undergoing laparoscopic inguinal hernia repair were selected and randomly divided into a control group(n=50)and an observation group(n=50).The control group received general anesthesia,while the observation group received an ultrasound-guided transverse fascia plane block combined with general anesthesia.The hemodynamic indexes such as heart rate(HR)and mean arterial pressure(MAP)at the time of admission(T1),5 minutes after the first anesthesia(T2),skin incision(T3)and the end of surgery(T4)were detected and compared between the two groups.A visual analogue scale(VAS)was used to evaluate the analgesic effect of the two groups at 6 h(T5),12 h(T6),24 h(T7)and 48 h(T8)after anesthesia.The operation time,postoperative recovery time and hospitalization time were recorded.The occurrence of adverse reactions in the two groups during hospitalization was recorded.Results At T2~T4,the HR and MAP of the two groups were lower than those at T1,but increased at T4,and the HR and MAP of the observation group were higher than those of the control group at T2-T4,and the indexes were compared among groups,time points,groups and time points(P<0.05).According to the analysis of the generalized estimation equation,VAS scores showed that there were significant differences between the two groups at T7 and T8 through the significance test of fixed effects of the intercept term(P<0.001),group(P<0.001),time point(P<0.001)and group time point interaction(P<0.001).Comparison of operation time between the two groups(P>0.05);The recovery time[(6.63±0.31)h]and hospitalization time[(3.09±0.31)d]of the observation group were shorter than those of the control group[(7.97±0.49)h,(5.47±0.47)d](P<0.05).The incidence of adverse reactions such as headache and pruritus between the two groups was compared(P>0.05).The incidence of adverse reactions such as nausea and vomiting in the observation group(2.00%)was lower than that in the control group(16.00%)(P<0.05).Conclusion Ultrasound-guided transverse fascial plane block combined general anesthesia has high application value in children undergoing inguinal hernia operation,a good postoperative analgesia effect,better recovery,a lower risk of adverse reactions,and good safety.