髂腹股沟及髂腹下神经联合阻滞在腹股沟疝日间手术患儿围手术期的麻醉效果

Anesthesia efficacy on ultrasound-guided IINB at perioperative period of children patients subject to day surgery of inguinal hernia

目的探讨超声引导下髂腹股沟-髂腹下神经联合阻滞(IINB)对腹股沟疝日间手术患儿围手术期的影响。方法将笔者所在医院收治的122例腹股沟疝患儿按照随机数字表法分为对照组和观察组,各61例。两组均行腹股沟疝日间手术,对照组进行常规全身麻醉,观察组在常规全身麻醉基础上于超声引导下行IINB,观察两组入室时(T0)、切皮时(T1)、术毕时(T2)血流动力学指标,包括心率(HR)、收缩压(SBP)、舒张压(DBP),记录其术中全身麻醉药物使用剂量、术后拔管时间、苏醒时间、躁动发生率、麻醉不良反应及术后追加使用曲马多镇痛情况,并以特殊患者疼痛评估量表(FLACC)评估两组患儿术后不同时间点疼痛程度。结果观察组T0时间点HR、SBP、DBP与对照组均无显著差异(P>0.05);T1、T2时间点HR、SBP、DBP均低于对照组(P<0.05)。观察组舒芬太尼和丙泊酚使用剂量均少于对照组(P<0.05),术后拔管时间、苏醒时间均短于对照组(P<0.05),躁动发生率和术后追加使用曲马多比率低于对照组(P<0.05),术后30 min、术后2 h、术后6 h和术后12 h FLACC评分均低于对照组(P<0.05),恶心、呕吐和呼吸抑制发生率与对照组比较差异无统计学意义(P>0.05)。结论超声引导下IINB有利于维持腹股沟疝日间手术患儿围术期血流动力学稳定,促进麻醉恢复。

Objective To explore the effects of ultrasound-guided ilioinguinal/iliohypogastric nerve block(IINB)on perioperative hemodynamics and anesthesia recovery in children patients subject to day surgery of inguinal hernia.Methods The 122 children patients with inguinal hernia admitted to author's hospital were divided into control group and observation group according to the random number table method,with 61 cases in each group.The two groups were given day surgery of inguinal hernia,and control group was given routine general anesthesia;and observation group was given ultrasound-guided IINB on the basis of routine general anesthesia.The hemodynamic parameters,including heart rate(HR),systolic blood pressure(SBP)and diastolic blood pressure(DBP),were observed in the two groups at entering(T0),at incision(T1)and at the end of surgery(T2),and the dosages of intraoperative general anesthetic drugs,postoperative extubation time,recovery time,incidence rate of agitation,adverse anesthesia reactions and postoperative additional tramadol analgesia were recorded,and the pain degree at different time points after surgery was evaluated by the Face,Legs,Activity,Cry,Consolability Behavioral Scale(FLACC).Results There were no significant differences in the HR,SBP and DBP between observation group and control group at T0(P>0.05).The HR,SBP and DBP at T1 and T2 were lower than those in control group(P<0.05).The dosages of sufentanil and propofol in observation group were lower than those in control group(P<0.05),and the postoperative extubation time and recovery time were shorter than those in control group(P<0.05),and the incidence rate of agitation and the rate of postoperative additional tramadol were lower than those in control group(P<0.05).At 30 min,2h,6h and 12h after surgery,the FLACC scores were lower than those in control group(P<0.05),and there were no significant differences in the incidence rates of nausea and vomiting and respiratory depression compared with those in control group(P>0.05).Conclusion Ultrasound-guided IINB is beneficial to maintain perioperative hemodynamic stability and promote anesthesia recovery in children patients subject to day surgery of inguinal hernia.