超声引导腹横肌平面神经阻滞用于婴幼儿腹股沟区手术的效果分析

Application of ultrasound-guided transversus abdominis plane block for operations of inguinal region in infants

选择美国麻醉医师协会（ASA）Ⅰ～Ⅱ级行单侧腹股沟区手术的婴幼儿150例,随机分为Ⅰ、Ⅱ、Ⅲ组各50例.入室后吸入七氟烷诱导,待脑电双频谱指数（BIS）值降至60后放入喉罩.Ⅰ、Ⅱ组在超声引导下穿刺腹横肌平面Ⅰ组注入0.25％罗哌卡因0.4 ml/kg,Ⅱ组注入0.5 ml/kg,Ⅲ组采用体表定位法注入0.5 ml/kg.分别在入室后（T1）、切皮时（T2）、提拉疝囊/鞘状突时（T3）、术毕时（T4）及苏醒时（T5）记录患儿的呼吸、心率、脉搏氧饱和度（SpO2）、呼气末二氧化碳（PET CO2）、七氟烷呼出浓度及BIS值,在恢复室及术后3、6h对患儿疼痛程度进行加拿大东安大略儿童医院疼痛评分表（CHEOPS）评分.结果显示,各组患儿术中出现镇痛不足比例组间差异有统计学意义（x^2=10.500,P=0.005）.Ⅰ、Ⅱ组在恢复室及术后3、6h的CHEOPS评分均低于Ⅲ组,术后6h之内按压镇痛泵者差异有统计学意义（x^2=7.230,P=0.027）.提示超声引导腹横肌平面神经阻滞用于婴幼儿腹股沟区手术效果优于传统的体表定位法,术后的镇痛效果确切.

One hundred and fifty ASA I - II infants scheduled to undergo surgery on unilateral inguinal region, were randomly assigned to 3 groups with 50 in each group. In groups I and II puncture was performed at traversus abdominis plane under ultrasound-guidance, 0. 4 or 0. 5/kg of 0. 25% ropivaeaine was injected respectively. In group m the triangle of Petit was positioned through palpating and then0. 5 ml/kg of 0. 25% ropivacaine was injected. HR, RR, SpO2, PETCO2, expired sevoflurane concentration and BIS value at the time of entering the operation room （ T1 ）, incision of skin （ T2 ）, pulling hernia sac （ T3 ）, ending the surgery （ T4 ） , waking （ T5 ）, the number of pressing the analgesia pump after operation were recorded. The results showed that HR at T2 and T3 of groups I and II was lower than group III （ P 〈 0.05 ）. The were significant differences in case numbers of insufficient intraoperative analgesia among 3 groups（ X^2 = 10. 500, P = 0. 005 ）. The CHEOPS scores and the number of pressing analgesia pump after operation in groups I and II were lower than those in group III （X^2 = 7. 230,P = 0. 027）. Results indicate that ultrasound-guided transversus abdominis plane block is safer and more effective than conventional method for operations of inguinal region in infants; it may reduce dose of local anesthetics and postoperative use of analgesics.