腹股沟疝患儿腰硬联合麻醉应用效果及安全性分析

Application and safety analysis of combined lumbar and dural anesthesia in children with inguinal hernia

目的探讨腰硬联合麻醉在学龄期腹股沟疝患儿麻醉中的应用及安全性。方法选取新乡新华医院2015-09-01-2018-09-01收治的94例学龄期腹股沟疝患儿作为研究对象,根据2组基线资料均衡可比的原则分为观察组和对照组,各47例。对照组采用静脉复合麻醉,观察组采用腰硬联合麻醉。对比2组麻醉前(T1)、麻醉后即刻(T2)、切皮时(T3)、气腹后即刻(T4)心率(HR)、平均动脉压(MAP),术前、术后12h血清肾上腺素(E)、去甲肾上腺素(NE)、白介素6(interleukin-6,IL-6)、白介素10(interleukin-10,IL-10)水平,及氯胺酮用量、苏醒时间和苏醒期不良反应发生率。结果T2时观察组MAP(t=3.554,P<0.001)和HR(t=3.595,P<0.001)水平高于对照组,T3时观察组MAP(t=4.442,P<0.001)和HR(t=2.862,P=0.005)水平低于对照组,T4时观察组MAP(t=6.894,P<0.001)和HR(t=6.502,P<0.001)水平低于对照组,差异有统计学意义。术后观察组E水平为(112.63±28.57)pg/mL,低于对照组的(236.58±37.26)pg/mL,t=18.098,P<0.001;观察组NE水平为(405.87±61.43)pg/mL,低于对照组的(591.64±78.54)pg/mL,t=12.773,P<0.001。术后2组血清IL-6(t=0.533,P=0.596)、IL-10(t=0.477,P=0.634)水平比较,差异无统计学意义。观察组氯胺酮用量为(79.28±25.37)mg,低于对照组的(148.36±39.58)mg,t=10.074,P<0.001;观察组苏醒时间为(18.69±9.17)min,低于对照组的(31.36±10.42)min,t=6.258,P<0.001;观察组苏醒期不良反应发生率为4.26%,低于对照组19.15%,差异有统计学意义,χ^(2)=5.045,P=0.025。结论腰硬联合麻醉应用于学龄期腹股沟疝手术患儿,可减轻应激反应程度,稳定血流动力学,减少麻醉药物用量,且安全性高,对血清细胞因子IL-6和IL-10水平无显著影响。

Objective The purpose of this study was to investigate the application and safety of combined spinal and epidural anesthesia in children with inguinal hernia.Methods A total of 94 school-age children with inguinal hernia admitted to Xinxiang Xinhua Hospital from September 1,2015 to September 1,2018 were selected as the study objects.According to the principle of balanced and comparable baseline data of the two groups,they were divided into the observation group and the control group,47 cases each.The control group was given intravenous compound anesthesia,and the observation group was given combined spinal epidural anesthesia.Before anesthesia(T1),immediately after anesthesia(T2),at the time of skin cutting(T3),immediately after pneumoperitoneum(T4),the heart rate(HR),mean arterial pressure(MAP),serum epinephrine(E),norepinephrine(NE),interleukin-6(IL-6),interleukin-10(IL-10)and the dosage of ketamine,the recovery time and the incidence of adverse reactions were compared between the two groups.Results MAP(t=3.554,P<0.001)and HR(t=3.595,P<0.001)levels in the observation group were higher than those in the control group at T2,MAP(t=4.442,P<0.001)and HR(t=2.862,P=0.005)levels in the observation group at T3 were lower than those in the control group,and MAP(t=6.894,P<0.001)and HR(t=6.502,P<0.001)levels in the observation group at T4 were lower than those in the control group.The E level of the observation group was(112.63±28.57)pg/ml,lower than that of the control group(236.58±37.26)pg/ml,t=18.098,P<0.001.The NE level of the observation group was(405.87±61.43)pg/ml,lower than that of the control group(591.64±78.54)pg/ml,t=12.773,P<0.001.There was no significant difference in serum IL-6(t=0.533,P=0.596)and IL-10(t=0.477,P=0.634)between the two groups.The dosage of ketamine in the observation group was(79.28±25.37)mg,lower than that in the control group(148.36±39.58)mg,t=10.074,P<0.001.The recovery time in the observation group was(18.69±9.17)min,lower than that in the control group(31.36±10.42)min,t=6.258,P<0.001.The incidence of adverse reactions in the recovery period in the observation group was 4.26%,lower than that in the control group(19.15%),the difference was statistically significant,χ^(2)=5.045,P=0.025.Conclusion Combined lumbar and dural anesthesia applied to school-age children with inguinal hernia surgery can reduce the degree of stress response,stabilize hemodynamics,reduce the amount of anesthetic drugs,and has high safety,but it has no significant effect on the levels of serum cytokines IL-6 and IL-10.