超声引导下腹横肌平面阻滞在小儿腹腔镜腹股沟疝手术中的应用

Ultrasound-guided laparoscopic inguinal hernia surgery blocked at transversus abdominal plane in children

目的探讨超声引导下腹横肌平面阻滞(TAP)在小儿腹腔镜腹股沟疝手术中的临床应用和效果。方法选取广州市妇女儿童医疗中心儿科2015年1月至2016年8月收治的60例腹股沟疝患儿作为研究对象。全部患儿随机分为TAP组和NS组,每组各30例。常规全麻诱导后,在超声引导下,TAP组患儿使用0.25%盐酸罗哌卡因行双侧TAP阻滞,NS组患儿在相同部位注射等量氯化钠溶液。术中以盐酸瑞芬太尼及七氟醚进行维持麻醉。观察2组患儿术前一般状况、术中生命体征、手术时间、术后苏醒时间、术后镇痛评分以及镇痛药物使用情况。结果 2组患儿术前在性别、年龄、身高和体重方面差异无统计学意义(P>0.05)。手术时间和术后苏醒时间差异均无统计学意义(P>0.05)。术中2组患儿切皮前心率(HR)、收缩压(SBP)、舒张压(DBP)及血氧饱和度(SpO_2)比较差异无统计学意义,而切皮2 min时TAP组患儿HR、SBP及DBP显著低于NS组(P<0.05),SpO_2差异无统计学意义(P>0.05)。TAP组患儿在苏醒时、术后30 min、术后6 h和12 h的静息和咳嗽时VAS评分显著低于NS组(P<0.01,P<0.05),而术后24 h,静息和咳嗽时VAS评分差异无统计学意义(P>0.05)。TAP组患儿在苏醒时、术后30 min、术后6、12 h的FLACC评分显著低于NS组(P<0.05),术后24 h的2组FLACC评分差异无统计学意义(P>0.05)。NS组术后静脉使用曲马多患儿8例(26.7%)显著高于TAP组2例(6.7%)(P<0.01)。结论超声引导下TAP阻滞能有效改善小儿腹股沟疝手术治疗时的生命体征,减轻患儿术后疼痛,减少镇痛药物的用量并提高家属的满意度。

Objective To investigate the effect of ultrasound guided transversus abdominal plane block （TAP） on laparoseopic inguinal hernia surgery in children. Methods Sixty children of inguinal hernia were randomly divided into two groups ： TAP group children were induced by bilateral ultrasound- guided TAP block intravenous anesthesia with 0. 25% ropivacaine hydroehloride （0. 5 mL/kg） on each side after intravenous anesthesia, NS group children were injected equal saline on each side. General anesthesia was maintained with 2% to 5% sevoflurane and remifentany 1 infusion. General conditions, intraoperative vital signs, operative time, postoperative recovery time, postoperative pain score and the use of tramadol were observed and compared. Results There were no significant differences in gender, age, height, weight, operation time and reeovery time between the two groups （P 〉 0.05）. During the surgery, there were no significant differences in the heart rate （ HR ）, systolic blood pressure （ SBP ）, diastolic blood pressure （DBP） and oxygen saturation （SpO2 ） of children before the skin incision; the HR, SBP and DBP of TAP group were significantly lower than that of the NS group 2 minutes after the skin incision （ P 〈 0.05 ）. VAS and FLACC pain scores of TAP group were significantly lower than those of NS group 30 minutes after recovery, 6 hours and 12 hours after the surgery （P 〈 0. 01 ,P 〈0.05）. However, there was no signifieant difference in VAS and FLACC scores between the two groups 24 hours after the surgery （ P 〉 0.05 ）. Eight patients in NS group （26.7%） received intravenous tramadol, two patients in TAP group （6.7 % ） received intravenous tramadol which was significantly lower than that of NS group （P 〈 0.01 ）. Conclusion TAP on laparoscopic inguinal hernia surgery in children can be safe and effectively improve the vital signs of during the surgery and relieve the pain of children after the surgery.