超声引导腹横肌平面阻滞联合纳布啡在小儿日间腹腔镜疝气修补术中的应用效果

Application of ultrasound-guided transversus abdominis plane(TAP)block combined with nalbuphine in daytime laparoscopic hernia repair in pediatrics

目的探讨超声引导腹横肌平面(TAP)阻滞联合纳布啡对小儿日间腹腔镜疝气修补术的影响。方法选取昆明市儿童医院126例美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级行日间腹腔镜手术患儿,按照随机数表法分为纳布啡组(n=65)和对照组(予以0.9%氯化钠注射液组)(n=61)。所有患儿采用静吸复合全身麻醉,均于手术开始前以0.25%罗哌卡因0.5 mL/kg实施超声引导下TAP阻滞。纳布啡组手术结束时给予纳布啡0.2 mg/kg,对照组手术结束时给予等量的0.9%氯化钠注射液。记录2组拔管时间、麻醉复苏室(PACU)停留时间、术后日间病房住院时间。观察麻醉苏醒期躁动、术后呼吸抑制、恶心呕吐及嗜睡的发生情况。采用小儿麻醉苏醒期躁动量化评分表(PAED)评估患儿苏醒期躁动程度,采用疼痛评分量表(CHEOPS)于患儿苏醒后1 h(T1)、2 h(T2)、4 h(T3)评估疼痛程度。结果2组拔管时间、PACU停留时间、术后日间病房住院时间及术后呼吸抑制、恶心呕吐和嗜睡的发生率差异无统计学意义(P>0.05)。纳布啡组术后发生苏醒期躁动为1例,对照组是6例,差异有统计学意义(P<0.05)。与对照组比较,纳布啡组患儿PAED评分和术后1 h、2 h、4 h的CHEOPS评分均降低,差异有统计学意义(P<0.05)。结论超声引导TAP阻滞联合纳布啡可以减少小儿日间腹腔镜疝气修补术的术后疼痛,降低麻醉苏醒期躁动发生率和躁动程度,且不良反应少。

Objective To investigate the efficacy of ultrasound-guided transversus abdominis plane(TAP)block combined with nalbuphine in daytime laparoscopic hernia repair in pediatrics.Methods A total of 126 children with ASA(American Society of Anesthesiologists)Ⅰ-Ⅱwho underwent the operation of laparoscopic hernia repair in Kunming Children′s Hospital were selected as subjects.They were divided into the nalbuphine group(n=65)and the saline group(n=61)according to the random number table method.All patients received intravenous inhalation compound anesthesia.The anesthesia was maintained by sevoflurane and propofol during the operation.Two groups were received ultrasound-guided TAP block with 0.25%ropivacaine 0.5 ml/kg.Nalbuphine(0.2 mg/kg)and the equal volume of normal saline were injected in the nalbuphine group and the saline group at the end of surgery.The extubation time,length of stay in the post anesthesia care unit(PACU)and hospital stay in day ward after operation were recorded.The emergence of agitation and postoperative respiratory depression,nausea,vomiting and drowsiness were observed.The degree of emergence agitation was assessed using the Pediatric Anesthesia Emergence Delirium(PAED)scale.Pain was evaluated using the Children′s Hospital of Eastern Ontario Pain Scale(CHEOPS)at the time point of T1(1 hour after recovery from anesthesia),T2(2 hours after recovery from anesthesia),T3(4 hours after recovery from anesthesia).Results There was no significant difference in the extubation time,length of stay in the PACU and day care ward after operation and the incidence of postoperative respiratory depression,nausea,vomiting and drowsiness between the two groups(P>0.05).There was 1 case of children with emergence agitation in the nalbuphine group,which were 6 cases in the saline group,and difference was found between them(P<0.05).Compared with the saline group,the PAED scores and the CHEOPS scores at each time point after surgery between the two groups were decreased in the nalbuphine group(P<0.05).Conclusions Ultrasound-guided TAP block combined with nalbuphine which can reduced postoperative pain in children undergoing daytime laparoscopic hernia repair,decreased the incidence of emergence agitation and degree of agitation,and the adverse reactions were less.