髂腹下-髂腹股沟-生殖股神经生殖支联合神经阻滞在老年患者无张力疝修补术中的应用

Iliohypogastric-ilioinguinal-genitofemoral nerve reproductive branch joint nerve block in elderly patients with tension-free hernia repairment

目的评价髂腹下-髂腹股沟-生殖股神经生殖支联合神经阻滞、蛛网膜下腔阻滞和局部麻醉对老年患者无张力疝修补术的麻醉效果、血流动力学影响及术后不良反应。方法选择120例行无张力疝修补术的老年患者,随机分为3组,每组40例,分别实施髂腹下-髂腹股沟-生殖股神经生殖支联合神经阻滞(A组)、蛛网膜下腔阻滞(B组)、局部麻醉(C组)。记录3组麻醉效果及麻醉前和麻醉后15、30、60、90 min的平均动脉压(MAP)和心率(HR),升压药的用量及术后情况。结果B组患者在麻醉后15 min和30 min的MAP明显低于A组、C组(P<0.05),B组尿潴留、头痛、恶心呕吐发生率显著高于A组、C组(P<0.05),患者满意度A组、B组显著高于C组(P<0.05)。结论应用神经刺激器定位技术下行髂腹下-髂腹股沟-生殖股神经生殖支联合神经阻滞的麻醉效果满意,对血流动力学影响小,不良反应少,是老年患者行无张力疝修补术理想的麻醉选择。

Objective To compare iliohypogastric-ilioinguinal-genitofemoral nerve reproductive branch joint block,subarachnoid block and local anesthesia in the elderly patients for tension-free hernia repairment and analyze the anesthetic effect,hemodynamics and postoperative adverse reactions.Methods One hundred and twenty elderly patients undergoing tension-free hernia repair were randomly divided into 3 groups,including iliohypogastric-ilioinguinal-genitofemoral nerve,the reproductive branch joint nerve block group（A group,n=40）,the subarachnoid block group（B group,n=40）,local anesthesia group（C group,n=40）.The anesthetic effect before anesthesia,and anesthesia after 15,30,60,90 min were recorded and the mean arterial pressure（MAP） and heart rate（HR）,vasopressor dosage and postoperative conditions were compared between the 3 groups.Results The MAP of 15 min,30 min after anesthesia in group B was significantly lower than those in group A,C（P 0.05）.The incidence of urinary retention,headache,nausea and vomiting in group B was significantly higher than that in group A,C（P 0.05）.Patient satisfaction in group A,B was significantly higher than those of group C（P 0.05）.Conclusion The anesthesia effect of iliohypogastric-ilioinguinal-genitofemoral nerve the reproductive branch joint nerve block is satisfactory,which has less hemodynamic effects and adverse reactions.So it is an ideal anesthesia option for elderly patients undergoing tension-free hernia repair.