超声引导下连续髂腹股沟-髂腹下神经阻滞与腹横肌平面阻滞在老年腹股沟疝手术中应用效果比较

Comparison of the application effect of continuous IINB and TAPB under ultrasound guidance in elderly inguinal hernia surgery

目的探讨超声引导下连续髂腹股沟-髂腹下神经阻滞(IINB)与腹横肌平面阻滞(TAPB)对老年腹股沟疝修补术镇痛效果、应激反应、不良反应的影响。方法前瞻性选取2020年5月至2022年5月,于文昌市人民医院行单侧腹腔镜下完全腹膜外疝修补术治疗的老年腹股沟疝患者84例为研究对象,按照随机数字表法分为观察组(予超声引导下连续IINB)与对照组(予超声引导下TAPB),各42例,对比Prince-Henry评分、去甲肾上腺素(NE)、皮质醇、首次按压镇痛泵时间、镇痛泵按压次数、罗哌卡因用量、睁眼时间及不良反应发生率。结果重复测量方差分析显示,2组Prince-Henry评分的时间效应、组间效应比较,差异有统计学意义(P<0.05),而时间与分组的交互作用比较,差异无统计学意义(P>0.05);2组NE、皮质醇的时间效应、组间效应、时间与分组的交互作用比较,差异有统计学意义(P<0.05);两两比较显示,观察组苏醒时、术后2、6、12、24 h的Prince-Henry评分低于对照组(P<0.05);观察组T1(切皮后30 min)、T2(术毕时)、T3(术后12 h)时点的NE、皮质醇低于对照组(P<0.05);观察组首次按压镇痛泵时间晚于对照组,镇痛泵按压次数少于对照组(P<0.05);2组罗哌卡因用量、睁眼时间、总不良反应发生率比较,差异无统计学意义(P>0.05)。结论超声引导下连续IINB在老年腹股沟疝修补术中具有较好镇痛效果,能降低应激反应,减轻疼痛。

Objective To investigate the influence of ultrasound-guided continuous ilioinguinal and ilioinferior ventral nerve block(IINB)and transversal abdominis plane block(TAPB)on the analgesic effect,stress response and adverse reactions of inguinal hernia repair in the elderly.Methods A total of 84 elderly patients with inguinal hernia who underwent unilateral complete peritoneal hernia repair under laparoscopy in Wenchang People's Hospital from May 2020 to May 2022 were selected as the study objects.According to the random number table method,they were divided into the observation group(receiving continuous IINB under ultrasound guidance)and the control group(receiving TAPB under ultrasound guidance),with 42 cases in each group.Prince-Henry score,norepinephrine(NE),cortisol,time of first analgesic pump compression,number of analgesic pump compression,dosage of ropivacaine,duration of eye opening and incidence of adverse reactions were compared.Results Repeated measurement ANOVA showed that the time effect and inter-group effect of the Prince Henry score between the two groups were statistically significant(P<0.05),while the interaction between time and group was not statistically significant(P>0.05).There were significant differences in the time effect,intergroup effect and interaction between time and group of NE and cortisol between the two groups(P<0.05).Pairwise comparison showed that the Prince-Henry scores of the observation group were lower than those of the control group at the time of recovery,2,6,12 and 24 hours after surgery(P<0.05).The NE and cortisol levels of T1(30 min after incision),T2(after surgery)and T3(12 h after surgery)in the observation group were lower than those in the control group(P<0.05).The first time of analgesic pump compression in the observation group was later than that in the control group,the times of analgesic pump compression were less than those in the control group(P<0.05).There was no significant difference in the dosage of ropivacaine,duration of eye opening,and the incidence of total adverse reactions between the two groups(P>0.05).Conclusion Ultrasound-guided continuous IINB has a good analgesic effect in elderly inguinal hernia repair,which can reduce the stress reactions and relieve pain.