超声引导双侧腹直肌鞘阻滞在小儿腹腔镜疝囊高位结扎术麻醉中的应用

Application of bilateral rectus sheath block guided by ultrasound in laparoscopic high ligation of hernia sac in children

目的观察超声引导下双侧腹直肌鞘阻滞在小儿腹腔镜疝囊高位结扎术中应用效果。方法收集盐城市妇幼保健院2018年1月至6月择期行腹腔镜疝囊高位结扎术的患儿56例,随机分为常规麻醉+双侧腹直肌鞘阻滞(腹直肌鞘阻滞组)和常规麻醉组,每组28例。记录切皮前(T1)、切皮时(T2)和腹腔镜镜头固定后(T3)3个时间点的心率和平均动脉压(MAP)。观察并记录拔除喉罩的时间、停留在麻醉复苏室的时间、手术后疼痛和躁动情况和麻醉使用芬太尼总量。结果常规麻醉组3个时间点MAP(F=23.76,P<0.001)和心率(F=21.53,P<0.001)差异有统计学意义,且T2时间点MAP和心率高于T1和T3时间点(P均<0.05),而腹直肌鞘阻滞组3个时间点MAP(F=0.41,P=0.53)和心率(F=2.14,P=0.06)差异无统计学意义。腹直肌鞘阻滞组T2时间点MAP和心率低于常规麻醉组(t=10.72,P<0.001;t=7.83,P<0.001);2组拔除喉罩时间、停留在麻醉复苏室的时间差异无统计学意义(P均>0.05)。术后常规麻醉组FLACC评分、躁动情况评分、使用芬太尼总量均明显高于腹直肌鞘阻滞组(P均<0.05)。结论超声引导下双侧腹直肌鞘阻滞可以减少小儿腹腔镜疝囊高位结扎术中脐部操作时血压和心率的波动,术后疼痛轻,芬太尼用量少,苏醒质量佳。

Objective To observe the effect of bilateral rectus sheath block(BRSB)guided by ultrasound in laparoscopic high ligation of hernia sac in children.Methods Fifty-six patients who underwent laparoscopic high ligation of hernial sac in children at Yancheng Maternity and Child Health Care Hospital from January to July 2018 were randomly divided into either a bilateral rectus abdominis sheath block group(group B)or a routine anesthesia group(group C),with 28 cases in each group.Heart rate and mean arterial pressure(MAP)were recorded at three time points,namely,prior to incision(T1),at incision(T2),and at laparoscopic lens fixation(T3).Time to removal of laryngeal mask,post-anesthesia care unit(PACU)stay,restlessness after operation,and total amount of fentanyl used in anesthesia were also recorded.Results MAP and heart rate at T2 in group C were significantly higher than those at T1 and T3(F=23.76,P<0.001;F=21.53,P<0.001),while MAP and heart rate at T2 in group B were not significantly different from those at T1 and T3(F=0.41,P=0.53;F=2.14,P=0.06);MAP and heart rate at T2 in group B were significantly lower than those in group C(t=10.72,P<0.001;t=7.83,P<0.001).There was no significant difference between the two groups in time to removal of laryngeal mask or duration of stay in PACU(P>0.05).The pain score,the incidence of agitation,and total amount of fentanyl in group C were significantly higher than those in group B(P>0.05).Conclusion Bilateral rectus block guided by ultrasound can reduce the fluctuation of blood pressure and heart rate,decrease the dosage of fentanyl used,and improve the quality of recovery during the operation of laparoscopic high ligation of hernia sac in children.