术前超前镇痛联合B型超声引导下神经阻滞镇痛方案在腹部手术患儿围术期中的应用效果

Application effect of preoperative preemptive analgesia combined with nerve block guided by B-mode ultrasound for analgesia in children undergoing abdominal surgery during perioperative period

目的探究术前超前镇痛联合B型超声引导下神经阻滞镇痛方案在腹部手术患儿围术期中的应用效果。方法选取腹部手术患儿120例为研究对象,随机将其分为A组(术前超前镇痛组)、B组(B型超声引导下神经阻滞组)、C组(术前超前镇痛联合B型超声引导下神经阻滞组)、D组(生理盐水组),每组30例。比较4组术后2,4,12,24,48 h阿片类药物用量、疼痛程度,比较4组切皮前后血流动力学指标[平均动脉压(mean artery pressure,MAP)、心率(heart rate,HR)]、复苏时间、不良反应发生情况。结果随时间延长,4组阿片类药物用量均呈升高趋势,C组阿片类药物用量最少,D组阿片类药物用量最多,组间、时点间、组间时点间交互作用差异有统计学意义(P<0.05)。4组FLACC评分均呈先升高后降低趋势,C组变化幅度最小,D组变化幅度最大,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。切皮后,4组MAP和HR均高于切皮前,C组MAP和HR显著低于A、B、D组,A、B组MAP和HR显著低于D组,差异有统计学意义(P<0.05)。4组复苏时间和不良反应发生率差异无统计学意义(P>0.05)。结论术前超前镇痛联合B型超声引导下神经阻滞镇痛方案在腹部手术患儿围术期中的应用效果较好,有助于稳定血流动力学状态及控制疼痛,因此应用价值较高。

Objective To investigate the application effect of preoperative preemptive analgesia combined with nerve block guided by B-mode ultrasound for analgesia in children undergoing abdominal surgery during perioperative period.Methods A total of 120 children undergoing abdominal surgery were selected as the research subjects,and then randomly divided into group A(preoperative preemptive analgesia group,n=30),group B(nerve block guided by B-mode ultrasound for analgesia group,n=30),group C(preoperative preemptive analgesia combined with nerve block guided by B-mode ultrasound for analgesia group,n=30)and group D(physiological saline group,n=30).The opioid dosage and pain severity at 2 h,4 h,12 h,24 h and 48 h after surgery,hemodynamic indexes[mean arterial pressure(MAP)and heart rate(HR)]before and after skin incision,resuscitation time and adverse reactions of four groups were compared.Results The opioid dosage of four groups was increased over time,withe the lowest dosage in group C and the highest dosage in group D;the interaction between groups,time points and time points between groups showed statistically significant differences(P<0.05).The FLACC score increased initially and decreased afterward,with the minimal change in groups C and the maximal change in group D;the interaction between groups,time points and time points between groups showed statistically significant differences(P<0.05).The MAP and HR of four groups after skin incision were all higher than those before skin incision;The MAP and HR of group C were significantly lower than those of groups A,B and D;the MAP and HR of groups A and B were significantly lower than those of group D,and there were statistically significant differences(P<0.05).No significant difference was found in the resuscitation time and adverse reaction rates of four groups(P>0.05).Conclusion The application effect of preoperative preemptive analgesia combined with nerve block guided by B-mode ultrasound for analgesia in children undergoing abdominal surgery during perioperative period is better,which is conductive to stabilization of hemodynamics and pain control.Therefore,it is of higher application value.