超声引导下连续髂腹下和髂腹股沟神经阻滞在高龄疝修补术后镇痛效果评价

ANALGESIC EFFECTS OF ULTRASOUND-GUIDED CONTINUOUS ILIOHYPOGASTRIC AND ILIOINGUINAL NERVE BLOCK IN THE ELDERLY AFTER HERNIA REPAIR

目的探讨超声引导下连续髂腹下和髂腹股沟神经阻滞在高龄疝修补术后的镇痛作用。方法选取2018年1月—2020年1月于该院行疝修补术的60例高龄腹股沟疝患者,随机数字表法分为对照组与观察组各30例,二组均常规麻醉诱导、维持,术毕观察组采用超声引导下连续髂腹下、髂腹股沟神经阻滞并置管,对照组仅行单次神经阻滞,不予置管,评估二组术后不同时间点视觉模拟评分(VAS)、舒适度评分(BCS)情况,记录二组术后24 h镇痛药物用量及术后下床活动时间、住院时间,测定术后即刻、术后24 h患者应激指标的变化,并分析阻滞相关不良反应发生率。结果观察组术后2 h(T1)、术后6 h(T2)、术后12 h(T3)和术后24 h(T4)VAS评分均低于对照组,BCS评分高于对照组(均P<0.05);观察组术后曲马多补救率略低于对照组,但差异无统计学意义(P>0.05),T4点N、NE均低于对照组(均P<0.05);二组阻滞相关不良反应发生率比较差异无统计学意义(P>0.05)。结论高龄疝修补术后采用超声引导下连续髂腹下和髂腹股沟神经阻滞镇痛作用完善,可提高患者舒适度,减少镇痛药物用量,降低手术应激反应。

Objective To investigate the analgesic effects of ultrasound-guided continuous iliohypogastric and ilioinguinal nerve block in the elderly after hernia repair.Methods Between January 2018 and January 2020,sixty elderly patients with inguinal hernia treated by hernia repair were recruited and randomly divided into two groups,control group(30 cases)and observation group(30 cases).Both groups received routine anesthesia induction and maintenance.After surgery,the observation group received ultrasound-guided continuous iliohypogastric and ilioinguinal nerve block and catheterization,while the control group received single nerve block without catheterization.The visual analogue scale(VAS)scores,bruggrmann comfort scale(BCS)scores,the dosage of analgesics in 24 h,postoperative ambulation time,and the length of hospital stay were recorded,changes in stress indicators immediately after surgery and at 24 h were determined,and the incidences of adverse reactions to block were counted.Results The observation group had lower VAS scores and higher BCS scores than the control group at 2 h(T1),6 h(T2),12 h(T3)and 24 h(T4)after operation(P<0.05).After operation,the observation group had a slightly lower tramadol remedy rate than the control group(P>0.05).At T4,N and NE were lower in the observation group than in the control group(P<0.05).No significant differences were found in the incidences of block-related adverse reactions between the two groups(P>0.05).Conclusion Ultrasound-guided continuous iliohypogastric and ilioinguinal nerve block can achieve perfect analgesic effect in elderly patients after hernia repair,which can improve patient comfort,reduce the dosage of analgesics,and reduce surgical stress response.