超声引导下腹横肌平面阻滞在小儿阑尾切除术中的应用

Application of Ultrasound-guided Horizontal Abdominal Muscle Block in Appendectomy in Children

目的探析超声引导下腹横肌平面阻滞(TAP)在小儿腹腔镜下阑尾切除术中的应用效果。方法选取2019年2月—2020年2月在我院收治的174例急性阑尾炎患儿作为观察对象,基于乱数表法分成研究组和对照组,各87例;均行腹腔镜下阑尾切除术,研究组采用超声引导下TAP,双侧各注入0.25%盐酸罗哌卡因0.5 mL/kg+0.1 mg/kg地塞米松;对照组给予等量生理盐水。对比分析两组术中生命体征、手术时间、苏醒时间、躁动评分及术后镇痛评分,并掌握不良反应情况。结果术中两组切皮前的心率(HR)、收缩压(SBP)、舒张压(DBP)以及血氧饱和度(SpO2)差异无统计学意义(P>0.05),切皮5 min研究组HR、SBP及DBP均低于对照组(P<0.05),SpO2差异无统计学意义(P>0.05)。两组手术时间、苏醒时间差异无统计学意义(P>0.05),研究组苏醒时躁动评分、FLACC评分低于对照组(P<0.05)。两组术后均未出现不良反应。结论在小儿腹腔镜阑尾切除术中应用超声引导下TAP安全有效,可减少躁动发生,减轻术后疼痛。

Objective To explore the effect of ultrasound-guided transverse abdominal plane block(TAP)in laparoscopic appendectomy in children.Methods 174 children with acute appendicitis admitted to our hospital from February 2019 to February 2020 were selected as the observation objects,and divided into study group and control group based on the method of random number table,87 cases in each group;laparoscopic appendectomy was performed in the study group,tap was guided by ultrasound,0.25%ropivacaine hydrochloride 0.5ml/kg+0.1mg/kg dexamethasone was injected into each side of the study group;the control group was given the same amount of normal saline.The vital signs,operation time,recovery time,restlessness score and postoperative analgesia score were compared between the two groups.Results There was no significant difference in heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP)and blood oxygen saturation(SpO2)between the two groups(P>0.05).HR,SBP and DBP of the study group were significantly lower than those of the control group(P<0.05)and SpO2 were not significantly different(P>0.05).There was no significant difference in operation time and recovery time between the two groups(P>0.05).The restlessness score and flacc score in the study group were significantly lower than those in the control group(P<0.05).There was no significant adverse reaction in both groups.Conclusion It is safe and effective to use tap guided by ultrasound in laparoscopic appendectomy in children,which can reduce the incidence of restlessness and postoperative pain.