局部神经阻滞麻醉下腹股沟疝无张力修补术围手术期晕厥22例

Inguinal hernia repair under local anesthesia: 22 cases of perioperative syncope

目的探讨局部区域神经阻滞麻醉下腹股沟疝围手术期内晕厥的原因和对策。方法回顾性分析2011年3月至2013年8月,河南省巩义市人民医院对进行379例腹股沟疝患者围手术期发生晕厥的22例患者行及时对症处理和原因分析。结果 17例患者在3 min内渐恢复,5例患者脉搏<45次/min,给予阿托品针0.5 mg静脉注射,5 min后渐恢复。间隔30 min监测生命体征1次至正常。恢复后均无精神、神经系统症状,其中4例因摔伤行皮肤清创缝合,3例推迟手术时间。患者无神经系统、心血管系统后遗症。结论麻醉药品、手术方式不是引起局部神经阻滞麻醉腹股沟疝围手术期出现晕厥的直接原因,围手术期内良好的医患沟通、对患者机体综合评估、充分的围手术期准备可预防和减少晕厥发生。

Objective To explore the causes and countermeasures of syncopein perioperative period of inguinal hernia repair under local nerve block anesthesia.Methods During March 2011 to August 2013, 22 out of 379 patients who underwent inguinal hernia repair in Gongyi People′s Hospital occurred perioperative syncope.All of them got prompt treatment in time,and the causes were analyzed.Results 17 patients gradually recovered in 3 minutes,and 5 patients were treated by injection of 0.5 mg atropine because of bradyarrhythmia （below 45/minutes）which return to normal in 5 minutes.The vital sign of patients were checked once per 30 minutes.After that,patients were free from mental or neurological symptoms,except for 4 cases of surgical debridement due to fall injury.No nervous or cardiovascular system sequelae was left.Conclusions Narcotic drugs or inguinal hernia operation itself is not the direct reason which causes the perioperative syncope ininguinal hernia repair under local nerve block anesthesia.While a good doctor-patient communication,comprehensive physiological evaluation and well-prepared perioperative management would help to prevent and reduce the occurrence of syncope.