超声引导下TAPB联合RSB在新生儿腹腔镜幽门环肌切开术中的麻醉应用

目的观察超声引导下的双侧腹横肌平面阻滞(TAPB)联合腹直肌鞘阻滞(RSB)对新生儿先天性肥厚性幽门狭窄(CHPS)行腹腔镜下幽门环肌切开术中的麻醉效果.方法选择行腹腔镜幽门环肌切开术新生儿40例,ASA分级Ⅰ-Ⅱ级,出生15~28d,采用随机数字表分为超声引导下TAPB联合RSB复合全身麻醉组(A组)和全身麻醉组(B组),每组各20例.气管插管后A组行超声引导下的双侧TAPB和双侧RSB.TAPB给予0.1%罗哌卡因0.4ml/kg,RSB给予0.1%罗哌卡因0.1ml/kg.两组均采用静吸复合麻醉,吸入七氟烷、静脉泵注瑞芬太尼维持麻醉,使BIS值在50~60.记录术中瑞芬太尼的用量;手术结束时七氟烷的吸入浓度及呼出浓度;记录手术时间、手术结束至拔除气管导管时间(拔管时间)、PACU滞留时间;记录需要补救镇痛、拔管时并发症如喉痉挛、PACU期间呼吸抑制(SpO2<90%,RR<15次/min)及恶心呕吐等不良反应发生情况.结果与B组比较,A组术中瑞芬太尼用量明显降低(P<0.05),A组拔管时间缩短(P<0.05);手术结束时七氟烷的吸入浓度、呼出浓度两组比较差异无统计学意义(P>0.05),PACU滞留时间两组比较差异无统计学意义(P>0.05);在拔管期B组4例(20%)患儿发生喉痉挛,在PACU期间B组20例(100%)患儿需要补救镇痛,3例(15%)患儿发生恶心呕吐;A组无一例不良反应的发生.结论超声引导TAPB联合RSB辅助全身麻醉减少新生儿腹腔镜幽门环肌切开术中瑞芬太尼的用量,缩短拔管时间,减少术后疼痛,麻醉效果优于单纯全身麻醉,增加新生儿上腹部手术麻醉的安全性.

Objective To evaluate the efficacy of bilateral ultrasound(US)-guided transversus abdominis plane block(TAPB)and rectus sheath block(RSB)for laparoscopic pyloromyotomy in neonates with congenital hypertrophic pyloric stenosis(CHPS).Methods Forty neonates(15~28days,ASA 1—2)for laparoscopic pyloromyotomy were randomized to TAPB and RSB combined with general anesthesia group(Group A;n=20)or general anesthesia group(Group B;n=20)by using a random number table.The TAPB and RSB were performed after tracheal intubation,the local anesthetic drugs was injected bilaterally on TAPB with 0.1% ropivacaine 0.4ml/kg and RSB with 0.1%ropivacaine O.lml/kg.All the participants were anesthetized by inhaling sevoflurane and intravenous infusion of remifentanil,and BIS was kept between 50-60.The dosage of remifentanil used in operation was recorded;the inhaled and exhaled concentration of sevoflurane at the end of the operation were recorded;the operation time,the extubation time and the length of stay in the PACU were recorded;the supplemental analgesics were recorded;complications such as laryngospasm during extubation,the occurrence of adverse reactions such as respiratory depression during PACU(SpO2<90%,RR<15 times per minute),nausea and vomiting were also recorded.Results Compared with group B,the dosage of remifentanil was significantly lower in group A(P<0.05);the extubation time was shortened in group A(P<0.05).There was no significant difference between the two groups in the inhaled and exhaled concentration of sevoflurane at the end of the operation(P>0.05).There was no significant difference in the PACU stay(P>0.05).Laryngospasm occurred in 4(20%)neonates in group B during extubation.20 neonates(100%)in group B needed the supplemental analgesics during PACU.Nausea and vomiting occurred in 3 neonates(15%)in group B.No adverse events were recorded in group A.Conclusion Ultrasound-guided TAPB and RSB assisted general anesthesia can reduce the dosage of remifentanil in neonates undergoing laparoscopic pyloromyotomy intraoperative,shorten the extubation time and reduce the postoperative pain.The anesthetic effect is superior to general anesthesia,and increase the safety of anesthesia in neonatal upper abdominal surgery.