超声引导下髂腹股沟-髂腹下神经阻滞联合局部麻醉在老年腹股沟疝修补术中的应用效果

Application of ultrasound-guided ilioinguino-iliohypogastric nerve block combined with local anesthesia in the repair of inguinal hernia in elderly patients

目的探究超声引导下髂腹股沟-髂腹下神经阻滞(IINB)联合局部麻醉在老年腹股沟疝无张力修补术中的应用效果。方法选取2019年2月至2021年2月在汉川市人民医院进行腹股沟无张力疝修补术的老年患者104例为研究对象,进行前瞻性研究。采用随机数字表法将患者分为试验组及对照组,各52例。对照组行蛛网膜下腔神经阻滞麻醉,试验组行超声引导下IINB联合局部麻醉。比较2组术后24、48、72 h疼痛视觉模拟评分(VAS),术前及术后24、48 h的应激反应指标[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、皮质醇]及在T0(麻醉前)、T1(麻醉10 min)、T2(切皮时)及T3(牵拉疝囊)及T4(缝皮时)时的血流动力学[心率、平均动脉压(MAP)及血氧饱和度(SpO_(2))]水平差异。结果静息时,试验组术后24、48、72 h的VAS评分低于对照组且差异有统计学意义(P<0.05)。活动时,2组患者术后24 h VAS评分差异无统计学意义(P>0.05),术后48、72 h的VAS评分差异有统计学意义(P<0.05)。T1、T2、T3、T4时刻,试验组心率高于对照组,T1、T4时刻,试验组MAP均高于对照组;T2、T3时刻SpO_(2)高于对照组(P<0.05);术后24、48 h试验组血清IL-6、TNF-α、CRP及皮质醇水平均低于对照组(P<0.05)。试验组总不良反应发生率较对照组低(9.62%vs 23.08%),但差异无统计学意义(χ^(2)=1.847,P=0.065)。结论超声引导下IINB联合局部麻醉在老年腹股沟疝无张力修补术中的麻醉效果好且安全性较高,可有效降低患者围手术期的应激及炎性反应,维持机体血流动力学稳定。

Objective To investigate the effect ultrasound-guided ilioinguino-iliohypogastric nerve block(IINB)combined with local anesthesia in tension-free inguinal hernia repair in elderly patients.Methods A prospective study was conducted on 104 elderly patients who underwent tension-free inguinal hernia repair in Hanchuan People's Hospital of Hubei Province from February 2019 to February 2021.Patients were divided into experimental group and control group using a random number table method,with 52 patients in each group.The control group was given subarachnoid nerve block anesthesia,and the experimental group was given IINB combined with local anesthesia under ultrasound guidance.The visual analogue scale(VAS)of pain at 24,48,and 72 hours after operation was compared between the two groups,and the stress response indexes[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)and cortisol]before and 24,48 hours after surgery,and hemodynamic[heart rate,mean arterial pressure(MAP),and oxygen saturation(SpO_(2))levels]at T0(before anesthesia),T1(after anesthesia for 10 minutes),T2(during skin incision),T3(when pulling hernia sac)and T4(during skin suture)were compared.Results At rest,the VAS scores of the experimental group were lower than those of the control group at 24,48,and 72 h postoperatively and the difference was statistically significant(P<0.05).During activity,the difference in VAS scores between the two groups was not statistically significant at 24 h after surgery(P>0.05),and the differences in VAS scores at 48 and 72 h after surgery were statistically significant(P<0.05).The heart rate of the experimental group was higher than that of the control group at the moments of T1,T2,T3,T4,and the MAP values of the experimental group were higher than those of the control group at the moments of T1 and T4;the SpO_(2) values of the experimental group were higher than those of the control group at the moments of T2 and T3(P<0.05);serum IL-6,TNF-α,CRP and cortisol levels in the experimental group were lower than those in the control group at 24 and 48 h after surgery(P<0.05).The incidence rate of total adverse reactions in the experimental group was lower than that in the control group(9.62%vs 23.08%),but the difference was not statistically significant(χ^(2)=1.847,P=0.065).Conclusion Under ultrasound guidance,IINB has good anesthesia effect and high safety in tension-free inguinal hernia repair in elderly patients,which can effectively reduce stress and inflammatory response during perioperative period and maintain hemodynamic stability of the body.