超声引导下腹横肌平面阻滞在小儿腹腔镜下腹股沟疝手术中的作用

The role of ultrasound guided transversus abdominis plane block in laparoscopic surgery for inguinal hernia in children

目的研究超声引导下腹横肌平面阻滞在小儿腹腔镜下腹股沟疝手术中的作用,为临床诊疗提供依据。方法选取2014年4月—2016年4月该院收治的腹股沟疝患儿124例,按照随机数字表法将患儿分为观察组和对照组,每组62例,两组均给予静脉全麻诱导,观察组应用超声引导下双侧腹横肌阻滞,两侧各注射0.25%罗哌卡因0.5 m L·kg^(-1),对照组给予等量生理盐水,手术中以芬太尼和七氟醚维持麻醉,应用Cravero评分法评价患者躁动情况,应用FLACC法评价患儿术后疼痛情况,比较两组患儿手术时间、苏醒时间、苏醒躁动发生率、Cravero评分、家长满意度、术后FLACC评分和追加镇痛药发生率。结果两组苏醒时间、手术时间比较差异无统计学意义(P>0.05);观察组躁动发生率、Cravero评分显著低于对照组,差异有统计学意义(P<0.05);观察组苏醒时,术后2、4、8 h FLACC评分分别为(2.01±0.02)、(1.92±0.31)、(1.63±0.53)、(0.83±0.29)分显著低于对照组同期,差异有统计学意义(P<0.05),两组术后12 h FLACC评分比较差异无统计学意义(P>0.05);观察组家长满意度为88.71%显著高于对照组的72.58%,追加镇痛药发生率为4.84%显著低于对照组的30.65%,差异有统计学意义(P<0.05)。结论超声引导下腹横肌平面阻滞在小儿腹腔镜下腹股沟疝手术具有较好效果,能有效降低患儿躁动,减轻术后疼痛。

Objective To study the role of ultrasound guided transversus abdominis plane block in laparoscopic surgery for inguinal hernia in children,to provide reference for future clinical diagnosis and treatment.Methods124cases of inguinal hernia in our hospital from April2014to April2016were selected,the children were divided into the study group and control group according to the random number table method,62cases in each group.Two groups were given intravenous anesthesia induction,the study group was treated with ultrasound-guided bilateral transversus abdominis block,injection of0.25%Ropivacaine0.5mL·kg-1on both sides,the control group was given the same amount of normal saline,fentanyl and maintained with sevoflurane anesthesia in the surgery.Cravero scoring method was applied to evaluate the patient′s restlessness,evaluated the postoperative pain in children with FLACC method.Compared the two groups of the operation time,recovery time,the incidence of agitation,Cravero score,parental satisfaction,postoperative FLACC score and the incidence of additional analgesics.Results There was no significant difference in recovery time,the operation time between the two groups(P>0.05);the incidence of agitation and Cravero score in the study group were6.45%and(2.19±0.53)points significantly lower than those38.71%and(3.42±0.46)points in the control group,the difference was statistically significant(P<0.05);the FLACC scores when waking up,2hours,4hours,8hours after operation of the study group were(2.01±0.02)points,(1.92±0.31)points,(1.63±0.53)points,(0.83±0.29)points significantly lower than those(3.72±0.13)points,(3.92±0.28)points,(3.36±0.27)points,(2.42±0.08)points in the control group,the difference was statistically significant(P<0.05).There was no significant difference in FLACC scores12hours after operation between the two groups(P>0.05);the parents′satisfaction in the study group was88.71%significantly higher than that72.58%in the control group;the incidence of additional analgesics was4.84%significantly lower than that of30.65%in the control group,the difference was statistically significant(P<0.05).Conclusions Ultrasound guides transversus abdominis plane block in laparoscopic surgery in children with inguinal hernia has a good effect.