超声引导腹横肌平面阻滞对儿童阑尾炎术后镇痛及心理应激的影响

Effects of ultrasound-guided tranversus abdominal plane block on the postoperative analgesia and psychological stress in children with appendicitis

目的分析超声引导腹横肌平面阻滞对儿童阑尾炎术后镇痛效果以及心理应激的影响。方法选择阑尾炎患儿120例,信封法随机分为研究组与对照组,每组60例,2组患儿均给予全身麻醉。术后研究组患者在超声引导下给予腹横肌平面阻滞,对照组患儿仅给予等剂量生理盐水腹横肌平面内局部注射,分别于术后6、12、24、36 h评估患儿疼痛程度;比较2组患儿术后肠蠕动恢复时间、芬太尼总用量、镇痛泵按压次数、恶心呕吐发生率、呼吸抑制发生率、尿潴留发生率以及1周内患儿梦魇、惊恐发生次数;比较2组治疗前后血清白介素-6(IL-6)与C-反应蛋白(CRP)水平。结果和对照组相比,研究组患儿术后不同时点疼痛评分明显降低(P<0.05);术后肠蠕动恢复时间、芬太尼总用量、镇痛泵按压次数、恶心呕吐发生例数、呼吸抑制发生例数、尿潴留发生例数均降低,1周内患儿梦魇、惊恐发生次数减少(P<0.05);治疗后24 h,血清IL-6与CRP水平降低(P<0.05)。结论超声引导腹横肌平面阻滞可以增强儿童阑尾炎术后镇痛效果,减少心理应激影响,可能与腹横肌平面阻滞减少儿童阑尾炎术后血清炎性反应水平有关。

Objective To analyze the effect of ultrasound guided transversus abdominis plane （TAP）block on the postoperative analgesia and psychological stress in children with appendicitis. Methods 120 children with appendicitis were randomly divided into two groups： the study group and the control group. All patients under- went general anesthesia. After operation, the patients in the study group were treated with ultrasound guided transversus abdominis plane abdominal nerve block anesthesia, the control group were given only equal dose of normal saline by abdominal transversus abdominis muscle plane. Respectively after 6, 12, 24, 36 h, the degree of pain assessment were compared between the two groups, the recovery time of intestinal peristalsis, the total dosage of fentanyl within 36 hours, analgesic pump pressing times, nausea and vomiting, respiratory depression, the incidence of urinary retention and within one week nightmares incidence, the occurrence of panic were also compared between the two groups. Before and twenty-four hours after the treatment, the level change of serum interleukin-6 （IL-6） and C-reactive protein （CRP） were measured. Results The pain scores of the study group were significantly lower than those of the control, group at different time points after surgery （P 〈 0.05）. The recovery time of intestinal peristalsis, the total dosage of fentanyl, postoperative analgesia pressing times, nausea and vomiting, respiratory depression, the incidence of urinary retention were also lower than that of the control group, the numbers of children with nightmares within one week, panic frequency in the study group were less than the control group, there was significant difference between two groups （P 〈 0.05）. After 24 hours of treatment, the levels of serum IL-6 and CRP in the study group were significantly lower than those in the control group （P 〈 0.05）. The difference was statistically significant （P 〈 0.05）. Conclusion Ultrasound-guided transversus abdominis plane block can enhance the analgesic effect of endo- scopic surgery of appendicitis in children, reduce the effects of psychological stress, the reason for analyzing this result is related to that transversus abdominis plane block reduce the level of inflammatory response in children with appendicitis postoperative.