单纯喉罩全身麻醉及合并超声引导腹横肌平面阻滞对小儿疝囊高位结扎术麻醉效果的影响

Anesthetic effect of laryngeal mask anesthesia alone and consolidated ultrasound-guided transversus abdominis plane block in high ligation of hernia sac in children

目的探讨单纯喉罩全身麻醉及合并超声引导腹横肌平面阻滞对小儿疝囊高位结扎术麻醉效果的影响,为临床麻醉方式提供参考。方法选择2013年1月-2015年1月行疝囊高位结扎术患儿140例,按照数字表法随机分为对照组与观察组,各70例。对照组单纯行喉罩全身麻醉,观察组行超声引导下腹横肌平面阻滞联合喉罩通气全身麻醉。对比两组患者不同时间点心率(HR)、平均动脉压(MAP)、苏醒时间、躁动率、不良反应等临床指标。结果观察组插入喉罩时HR及MAP分别为(128.58±9.11)次/min和(31.18±3.24)mm Hg,低于对照组,差异有统计学意义(P<0.01),观察组拔除喉罩时HR及MAP分别为(128.48±8.94)次/min和(34.51±3.95)mm Hg,低于对照组,差异有统计学意义(P<0.05);观察组苏醒时间、手术时间、瑞芬太尼用量分别为(6.14±0.98)min、(16.69±3.05)min和(99.34±7.16)μg,低于对照组,差异有统计学意义(P<0.05);观察组躁动评分、躁动率、12 h小儿疼痛量表(FLACC)评分分别为(2.48±0.35)分、8.57%和(2.38±0.59)分,低于对照组,差异有统计学意义(P<0.05);观察组不良反应发生率为5.71%,低于对照组(17.14%),差异有统计学意义(P<0.05)。结论疝囊高位结扎术患儿应用喉罩全身麻醉联合超声引导腹横肌平面阻滞麻醉效果好,患儿体征稳定,躁动率低,不良反应发生率低,值得临床推广应用。

Objective To investigate clinical effect of laryngeal mask anesthesia alone and consolidated ultrasound-guided transversus abdominis plane block in high ligation of hernia sac in children so as to provide a reference for clinical treatment. Methods A total of 140 children who underwent hernia sac ligation from January 2013 to January 2015 were selected. According to the digital form they were randomly divided into control group and observation group with 70 cases in each group. The patients in the control group received laryngeal mask anesthesia, while the cases in the observation group had ultrasound-guided transversus abdominis plane block combined with laryngeal mask airway anesthesia. Heart rate（HR）, mean arterial pressure（MAP）, recovery time, agitation rate and adverse reactions were compared between the two groups at different time points. Results At the time of insertion of laryngeal mask, HR and MAP were（128.58 ± 9.11）times/min,（31.18 ± 3.24） mm Hg in the observer group, which were significantly lower than those in the control group（P〈 0.01）. At the time of removal of laryngeal mask, HR and MAP were（128.48 ± 8.94） times/min,（34.51 ± 3.95） mm Hg in the observation group, which were significantly lower than those of the control group（P〈 0.05）. The recovery time [（6.14 ± 0.98） min] and surgery time [（16.69 ± 3.05） min] were significantly shorter（t =21.479, P〈 0.01; t = 5.266, P〈 0.01）, and Remifentanil dose [（99.34 ± 7.16） μg] was significantly lower in the observation group than in the control group（t = 25.570, P〈 0.01）. Restlessness score and agitation rate in the observation group were（2.48 ± 0.35） and 8.57% respectively, which were significantly lower than those in the control group（P〈 0.05）. The adverse reaction rate of the observation group was 5.71%, which was significantly lower than17.14% of the control group（P〈 0.05）. Conclusions For high ligation of hernia sac in children, laryngeal mask anesthesia combined with ultrasound-guided transversus abdominis plane anesthesia has good clinical effect, can help children to maintain stable signs with low agitation rate and low incidence of adverse reactions. Therefore, it is worthy of clinical application.