超声引导腹横肌平面阻滞联合髂腹下髂腹股沟神经阻滞在老年腹股沟疝手术中的应用

Application of ultrasound guided transversus abdominis plane block combined with hypogastric hypogastric nerve block in elderly inguinal hernia surgery

目的探讨老年腹股沟疝手术中超声引导腹横肌平面阻滞联合髂腹下髂腹股沟神经阻滞的麻醉效果。方法选择老年腹股沟疝手术患者90例,ASAⅡ~Ⅲ级,采用随机双盲法分为超声引导腹横肌平面阻滞联合髂腹下髂腹股沟神经阻滞组(TⅠ组)、腰硬联合麻醉组(CS组),各45例。记录麻醉前(T0)、麻醉后10min(T1)、手术开始(T2)、牵拉疝囊(T3)、手术结束(T4)、术后6h(T5)、术后12h(T6)、术后24h(T7)的MAP、HR、SPO_2的变化、VAS疼痛强度评分及麻醉不良反应、麻醉效果的情况并进行统计学分析。结果 CS组T1、T2、T3与T0比较MAP明显下降(P<0.05);与TI组比较T1、T2、T3时段MAP下降明显(P<0.05)。TⅠ组与CS组比较,T2、T3、T4、T7时VAS评分(P>0.05);T6时术后疼痛强度明显较轻(P<0.05)。麻醉不良反应TⅠ组明显较少(P<0.05);麻醉效果评价两组差异无统计学意义(P>0.05)。结论老年腹股沟疝手术中超声引导腹横肌平面阻滞联合髂腹下髂腹股沟神经阻滞的麻醉效果确切,对生理干扰少,是一种安全、可靠的麻醉方法。

Objective To probe into the anesthetic effects of ultrasound guided transversus abdominis plane block combined with hypogastric hypogastric nerve block in elderly inguinal hernia surgery. Methods Ninety elderly patients undergoing inguinal hernia operation(ASA Ⅱ-Ⅲ) were randomly divided into two groups:ultrasound guided transverse muscle block combined with inferior iliac inguinal nerve block(TⅠ group) and spinal epidural anesthesia group(CS group),45 cases in each group.Then,the changes of MAP,HR,SPO_2,and VAS pain intensity scores,the adverse reactions of anesthesia and the anesthesia effects before anesthesia(T0),after anesthesia for 10 min(T1),surgical start(T2),pull hernia sac(T3),end of operation(T4),after operation for 6 h(T5),after operation for 12 h(T6),after operation for 24 h(T7) were recorded and statistically analyzed. Results Compared with group T0,the MAP of T1,T2,T3 in the CS group were significantly decreased(P < 0.05);Compared with group TI,the MAP in the T2 and T3 were significantly decreased(P < 0.05).Comparison between group TI and group CS,there was no significant difference in VAS scores in T2,T3,T4,and T7(P > 0.05);The intensity of pain after operation for T6 was significantly lighter(P < 0.05).The adverse reaction of anesthesia in the TⅠ group were less(P < 0.05);There was no significant difference in the evaluation of anesthetic effect between the two groups(P > 0.05). Conclusion The anesthetic effects of ultrasound guided transversus abdominis plane block combined with hypogastric hypogastric nerve block in elderly inguinal hernia surgery are exact,which it has less physical interference,and it is safe and reliable method of anesthesia.