三种神经阻滞方法在老年人腹股沟无张力疝修补术中应用的比较

Comparison of three nerve block methods in inguinal tension-free hernioplasty of the elders

目的寻找老年人腹股沟无张力疝修补术理想的麻醉方式。方法深圳市人民医院麻醉科自2010年6月至2015年4月分别在蛛网膜下腔神经阻滞麻醉（20例）、局部浸润麻醉（20例）超声引导下髂腹下-髂腹股沟神经阻滞（20例）下行老年人腹股沟无张力疝修补术60例，比较3组患者术中不同时间点平均动脉压和心率、术中术后镇痛药用量、术中视觉模拟评分（VASl、术后尿潴留发生率以及麻醉满意度。结果与麻醉前（T0）、术后24h（T5）比较，蛛网膜下腔神经阻滞组患者麻醉完成后（T1）、切皮后（T2）、手术结束时（T3）、术后6h（T4）的平均动脉压、心率降低，差异有统计学意义（P〈O．05）。蛛网膜下腔神经阻滞组患者T1、T2、T3、T4时间点的平均动脉压、心率低于另外2组，差异有统计学意义（P〈0．05）；局部浸润麻醉组患者术中曲马多的用量大于其他2组．蛛网膜下腔神经阻滞组患者术后曲马多用量大于其他2组，差异均有统计学意义（P〈0．05）；蛛网膜下腔神经阻滞组患者术后均发生尿潴留，另外2组患者均未发生。局部浸润麻醉组患者术中VAS评分高于另外2组，蛛网膜下腔神经阻滞组患者术后VAS评分高于另外2组．差异均有统计学意义（P〈0．05）；超声引导下髂腹下．髂腹股沟神经阻滞组患者麻醉满意度评价最高（蛛网膜下腔神经阻滞组、局部浸润麻醉组、超声引导下髂腹下-髂腹股沟神经阻滞组平均秩次分别为20．1、23．9、47．5）。结论超声引导下髂腹下-髂腹股沟神经阻滞麻醉效果确切，术中术后镇痛效果较好，对患者血流动力学影响较小，术后尿潴留发生率低，且患者满意度较高，是老年人行腹股沟无张力疝修补术的一种较为理想的麻醉方式。

Objective To find a satisfactory way of anesthesia for inguinal surgery of the elders. Methods Inguinal tension-free hernioplasty was performed in 60 elderly patients in our hospital from June 2010 to April 2015; according to the anesthesia methods, three groups （n=20） were divided： patients from Group A were used spinal canal anesthesia, those from Group B were used local anesthesia and those from Group C were used ultrasound guided ilioinguinal-iliohypogastric nerve block. Blood pressure and heart rate, intra-operative and postoperative analgesic dosages, intra-operative visual analogue scale （VAS）, postoperative urinary retention and anesthesia satisfaction were compared among the three groups at difference time points. Results As compared with those in group A before anesthesia （TO） and 24 h after surgery （T5）, the blood pressure and heart rate in Group A after the anesthesia （T1）, after skin incision （T2）, right after surgery （T3） and 6 h after surgery （T4） were significantly decreased （P〈0.05）. The blood pressure and heart rate in Group A were significantly lower than those in the other two groups at T1, T2, T3 and T4 （P〈0.05）. Intra-operative tramadol dosage in group B was significantly higher than that in the other two groups （P〈0.05）, while post-operated tramadol dosage in group C was statistically higher than that in the other two groups （P〈0.05）. Postoperative urinary retention appeared in all patients of group A, while not in other two groups. Intra-operative VAS scores in group B were significantly higher than those in the other two groups （P〈0.05）. Post-operative VAS scores in group A were significantly higher than those in the other two groups （P〈O.05）. Patients in group C had the highest satisfactory evaluation （mean rank in group A, group B and group C were 42.95, 28.28 and 20.27）. Conclusion The effect of ultrasound guided ilioinguinal-iliohypogastric nerve block is exact, enjoying good intra-operative and postoperative analgesic effect, small influence on hemodynamics in patients, low incidence of postoperative urinary retention and high patient satisfaction; therefore, it is an ideal anesthesia of the inguinal surgery of the elders.