两种麻醉方法在小儿腹股沟斜疝手术中的效果比较

Comparison of Effect on Two Anaesthetic Techniques in Pediatric Inguinal Hernia Surgery

目的:比较髂腹下/髂腹股沟神经阻滞与骶管阻滞在小儿腹股沟斜疝手术中的临床效果。方法:选取择期行单侧腹股沟斜疝手术患儿120例,随机分为髂腹下/髂腹股沟神经阻滞复合静脉全麻组(A组)和骶管阻滞复合静脉全麻组(B组)。记录入手术室时(T0)、手术切皮时(T1)、手术结束时(T2)各时间点患儿的HR、Sp O2和MAP的变化;记录麻醉起效时间、麻醉持续时间、苏醒时间、术中舒芬太尼、丙泊酚总用量以及术中、术后患儿不良事件发生情况;于患儿苏醒时、术后2 h和术后4 h行FLACC疼痛评分。结果:两组患儿HR、Sp O2和MAP在各时间点无明显变化;A组麻醉起效时间明显缩短(P<0.05);两组术中及术后不良反应发生率低且差异无统计学意义,B组术后出现1例尿潴留;两组苏醒时间及术后镇痛效果比较差异无统计学意义。结论:静脉全身麻醉复合髂腹下/髂腹股沟神经阻滞或者骶管阻滞均可安全有效地用于小儿腹股沟斜疝手术麻醉,但前者起效快、操作简单,更易满足日间手术安全、快捷的要求。

Objective： To compare the clinical effect of IINB（ ilioinguinal/iliohypogastrie nerve block） and caudal block in pediatric inguinal hernia surgery. Methods： One hundred and twenty children required inguinal hernia surgeries were randomly divided into two groups： IINB group（ group A） and caudal block group（ group B）. The vital signs of heart rate（ HR）,pulse oxygen saturation（ Sp O2）,mean arterial pressure（ MAP） were recorded in three time points during surgery： the basal（ T0）,the skin incision（ T1） and the end of the surgery（ T2）. The onset and duration time of anesthesia,the total dosage of sufentanil and propofol,the awakening time and intra-or-postoperation adverse events were also recorded. Face legs activity cry consolability（ FLACC） score was used to assess the pain score postoperative at the awakening time,2 h and 4 h postoperation respectively. Results： HR,Sp O2 and MAP at three time points in the two groups were no significantly difference（ P 〉 0. 05）. The onset time of anesthesia in group A was shorten obviously（ P〈0. 05）. The incidence of adverse reactions intra-or-postoperation was low and no significantly difference in the two groups（ P〉0. 05）,but one case had emerge urinary retention postoperation in group B. The recovery time and the effect of postoperative analgesia were no significantly difference（ P〉0. 05）. Conclusion： The IINB and caudal block combined with general anesthes are both safe and effective in pediatric inguinal hernia surgery. With shorter onset time,fewer complications,and easier to operate,IINB is a proper choice for pediatric ambulatory surgery.