腹股沟疝手术患儿髂腹股沟神经-髂腹下神经阻滞联合异丙酚靶控输注的效果

Efficacy of ilioinguinal and iliohypogastric nerve block combined with propofol by TCI in children undergoing inguinal hernia repair

目的评价腹股沟斜疝疝囊结扎术患儿髂腹股沟神经-髂腹下神经阻滞联合异丙酚靶控输注的效果。方法择期行腹股沟斜疝疝囊结扎术患儿30例,年龄7月～7岁,体重8～24kg,ASAⅠ级,根据Marsh参数,靶控输注异丙酚,在效应室浓度达到4．5μg/ml时,行髂腹股沟神经-髂腹下神经阻滞。记录入室时（T0）、切皮前（T1）、切皮后1、5、10min（T2-4）和术毕（T5）的心率（HR）、呼吸频率（RR）、脉搏血氧饱和度（SpO2）,记录术中及术后并发症的发生情况、苏醒时间、术后2、4h的镇痛效应及术后4h患儿家长的满意情况。结果患儿各时点HR、RR、SpO2均在正常范围；苏醒时间为30～52 min；术后2、4h时患儿镇痛有效率分别为80%和93%；术后4h时患儿家长满意率为83%。结论腹股沟斜疝疝囊结扎术患儿髂腹股沟神经-髂腹下神经阻滞联合异丙酚靶控输注时,麻醉效果安全可靠,术后镇痛效果良好。

Objective To investigate the efficacy of ilioinguinal-iliohypogastric nerve block combined with TCI propofol in children undergoing inguinal hernia repair. Methods Thirty children ASAⅠ aged 7 month -7 yr weighing 8-24 kg scheduled for inguinal hernia repair were selected. The patients received TCI propofol driven by the Marsh model in effect site control until the end of surgery. After sedation was induced with TCI propofol at effect-site concentration of 4.5 μg/ml, the mixture of 0.7 % lidocaine and 0.2 % bupivacaine 0.25 ml/kg was administered to perform an ilioinguinal-iliohypogastric nerve block. Heart rate, respiratory rate and SpO2 were monitored before TCI propofol, before skin incision, at 1,5 and 10 min after incision , and at the end of the surgery. The occurrence of perioperative complications, the time of palinesthesia, efficacy of postoperative analgesia and satisfaction of parents were recorded. Results Heart rate, respiratory rate and SpO2 were maintained within normal range at different time. The time of palinesthesia was 30-52 min. The effective analgesia rate was 80% and 93% at 2 h and 4 h after operation. The parents satisfactory rate of postoperative pain relief was 83%. Conclusion The iliohypogastric-ilioinguinal nerve block combined with TCI propofol sedation exerts reliable anesthesia efficacy and satisfactory postoperative analgesia with few perioperative complications in children undergoing inguinal hernia repair.