超声引导下腹横肌平面阻滞联合喉罩通气全身麻醉在儿童腹股沟疝修补术中的应用

Application of ultrasound-guided transverse abdominal plane block combined with laryngeal mask ventilation for general anesthesia in children with inguinal hernia

目的探究超声引导下腹横肌平面(TAP)阻滞联合喉罩通气全身麻醉在儿童腹股沟疝修补术中的应用。方法前瞻性分析2017年1月至2019年1月,江油市第二人民医院行腹腔镜疝囊高位结扎术的腹股沟疝患儿160例,随机分为观察组和对照组,每组患者80例。观察组在超声引导下予0.25%盐酸罗哌卡因行TAP阻滞联合喉罩通气全身麻醉,对照组仅行喉罩通气全身麻醉。对比分析2组患儿的一般情况、手术相关指标、术中血流动力学指标、麻醉相关并发症、镇痛效果及血沉(ESR)、超敏C反应蛋白(hsCRP)等炎性指标。结果观察组患儿的手术时间与对照组比较,差异无统计学意义(P>0.05);观察组患儿的术后苏醒时间和住院时间均短于对照组患儿,差异有统计学意义(P<0.05)。与麻醉诱导前(T1)相比,观察组患儿在插入喉罩时(T2)、手术开始时(T3)和拔除喉罩时(T4)的心率和平均动脉压无明显变化(P>0.05);对照组患儿的平均动脉压无显著变化(P>0.05),但心率明显升高(P<0.05)。观察组和对照组患儿术后恶心和呕吐的发生率均有显著差异(P<0.05),其余麻醉相关并发症无差异。观察组患儿术后躁动评分和疼痛评分均低于对照组患儿(P<0.05)。2组患儿术前、术后的ESR和hsCRP均无明显差异(P>0.05)。结论超声引导下TAP阻滞联合喉罩通气全身麻醉可以有效维持术中心率和血压稳定,减轻术后躁动,缩短麻醉苏醒时间,还可以减少术后恶心呕吐的发生,镇痛效果更加明显,有利于缩短住院时间。

Objective To explore the effect of ultrasound-guided transverse abdominal plane(TAP)block combined with laryngeal mask ventilation general anesthesia in children with inguinal hernia.Methods The clinical data of children with inguinal hernia who underwent laparoscopic hernia sac high ligation in Jiangyou second people's hospital from January 2017 to January 2019 were randomly divided into observation group and control group,with 80 patients in each group.The observation group underwent ultrasound anesthesia with 0.25%ropivacaine hydrochloride for TAP block combined with general laryngeal mask ventilation,while the control group received general laryngeal mask general anesthesia.The general conditions,surgical-related indicators,intraoperative hemodynamic indicators,anesthesia-related complications,analgesic effects and erythrocyte sedimentation(ESR),high-sensitivity C-reactive protein(hsCRP)and other inflammatory indicators were compared and analyzed in the two groups.Results Compared with the control group,the operation time of children in the observation group was not statistically different(P>0.05).The anesthesia wake-up time and hospital stay of the observation group were shorter than those of the control group(P<0.05).Compared with those before induction of anesthesia(T1),there were no significant changes in HR and MAP of the observation group when the laryngeal mask was inserted(T2),when the operation was started(T3),and when the laryngeal mask was removed(T4)(P>0.05);There was no significant change in MAP in the control group(P>0.05),but the HR was significantly increased(P<0.05).The incidence of postoperative nausea and vomiting in the observation group and the control group were significantly different(P<0.05),and there were no differences in the rest of the anesthesiarelated complications.Patients in the observation group had lower postoperative restlessness scores and pain scores than those in the control group(P<0.05).There were no significant differences in ESR and hsCRP between the two groups of children before and after operation(P>0.05).Conclusion Ultrasoundguided TAP block combined with laryngeal mask ventilation general anesthesia can effectively maintain the intraoperative heart rate and blood pressure stability,reduce postoperative restlessness,shorten the anesthesia recovery time,and reduce the incidence of postoperative nausea and vomiting.The analgesic effect is more obvious,and it helps to shorten the length of hospital stay.