骶管阻滞复合全麻对小儿腹腔镜手术后肠道功能恢复的影响

Effects of General Anesthesia Versus combined Caudal Block on Postoperative Intestinal Canal Function Recovery in the Pediatric Patients undergoing Laparoscopic Surgery

目的比较骶管阻滞复合全身麻醉和单纯全身麻醉对小儿腹腔镜手术术后肠道功能恢复的影响。方法择期行腹腔镜手术的患儿60例(疝囊高位结扎术、睾丸下降固定术、鞘状突高位结扎术),性别不限,年龄1~3岁,体质指数12~18kg·m^(-2),ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为全麻组(A)和骶管阻滞复合全麻组(B)各30例。记录患者麻醉诱导前(T_0,基础状态)、置入喉罩后5min(T_1)、手术开始后5min(T_2)、手术结束(T_3)、拔除喉罩后(T_4)两组患儿的平均动脉压(MAP)和心率(HR);于T_0、切皮后30min(T_5)、术后30min(T_6)采集静脉血,用ELISA法检测血清中去甲肾上腺素(NE)、皮质醇激素(COR)、白介素-6(IL-6)、白介素-10(IL^(-1)0)、肠脂肪酸结合蛋白(IFABP)浓度;记录两组术前禁饮食时间,术中异丙酚及瑞芬太尼用量、手术时间、术后初次排气时间、初次排便时间、二次排便时间。结果 A组MAP、HR T_2、T_3、T_4时与T_0相比差异有统计学意义(P<0.05),B组MAP、HR T_2、T_3时与T_0相比差异有统计学意义(P<0.05),与A组比较,B组T_2、T_4时MAP、HR降低(P<0.05);与T_0相比,两组T_5、T_6时Cor、IL^(-1)0、IFABP水平升高(P<0.05);与T_0相比,A组T_5、T_6时NE水平升高(P<0.05),与A组比较,B组T_5、T_6时NE水平降低(P<0.05);两组患者异丙酚用量、初次排气时间、初次排便时间、二次排便时间比较差异均无统计学意义(P均>0.05);A组瑞芬太尼用量多于B组(P<0.01)。结论骶管阻滞复合全身麻醉相比全身麻醉可以抑制小儿腹腔镜手术中感受性刺激引起的应激反应,不能抑制非感受性刺激引起的应激反应,不能加速术后肠道功能的恢复。

Objective To compare the effect of general anesthesia versus combined caudal block on postoperative intestinal canal function recovery in the pediatric patients undergoing laparoscopic surgery.Methods Sixty patients（high ligation of hernial sac,cryptorchidopexy,high ligation of patent）of both genders,aged 1-3 year,BMI 12-18kg·m^-2,of ASA physical status I orⅡ,were randomly divided into either general anesthesia group（group A,n=30）or combined caudal block-general anesthesia group（group B,n=30）. The mean arterial pressure（MAP）and heat rate（HR）before induction of anesthesia（T0,baseline）,at 5 min after laryngeal mask was placed（T1）,at 5min after operation（T2）,the time for the end of surgery（T3）,the time for removal of laryngeal mask（T4）were recorded. Before induction of anesthesia（T0）,and at 30 min after skin incision（T5）,at 30 min after surgery（T6）,blood samples were collected the peripheral vein for determination of the plasma NE,COR,IL-6,IL-10,IFABP by enzyme-linked immunosorbent assay. Surgery time,the intraoperative consumption of propofol and remifentanil,the initial time of postoperative gas and stool,the second time of stool were recorded. Results Compared with T0,the MAP and HR was both increased significantly at T2,T3,T4 in group A（P〈0.05）. Compared with T0,MAP and HR were increased at T2,T4 in group B. Compared with group A,the MAP and HR was significantly decreased in group B（P〈0.05）. Compared with T0,the concentration of Cor,IL-10,IFABP was increased at T5,T6 in group A and B（P〈0.05）. Compared with T0,the concentration of NE was increased at T5,T6 in group A（P〈0.05）. There was no significant difference in intraoperative consumption of propofol,the time of preoperative fasting and water-deprivation,the initial time of postoperative gas and stool,the second time of stool among group A and B（P〈0.05）. However,compared with group A,intraoperative consumption of remifentanil was decreased in group B（P〈0.01）. Conclusion Compared with general anesthesia,general anesthesia combined sacral anesthesia inhibits the stress response caused by intraoperative nociceptive stimulation for pediatric patients undergoing laparoscopic surgery,but it has no effect on the stress response caused by intraoperative non-nociceptive stimulation as well as postoperative intestinal canal function recovery.