两种麻醉方式对腹腔镜疝气手术患儿血流动力学及苏醒质量的影响

Effects of anesthesia methods on hemodynamics and quality of recovery in children undergoing laparoscopic hernia surgery

目的分析全身麻醉复合骶管阻滞与全身麻醉复合腹横肌平面阻滞对腹腔镜疝气手术患儿血流动力学及苏醒质量的影响。方法选取2016年5月—2021年5月芜湖市第一人民医院收治的腹股沟疝患儿140例,患儿均行腹腔镜疝气手术治疗,并按随机数表法分为全身麻醉复合骶管阻滞(GS)组、全身麻醉复合腹横肌平面阻滞(GT)组,每组70例。比较两组苏醒质量、血流动力学、Ramsay镇静评分、麻醉苏醒期躁动(PAED)评分、不良反应。结果GS组拔管时间、睁眼时间及意识恢复时间较GT组短(P<0.05)。两组T_(0)、T_(1)、T_(2)、T_(3)、T_(4)时间点SBP、DBP、HR比较,经重复测量设计的方差分析,结果:①不同时间点的SBP、DBP、HR有差异(P<0.05);②两组SBP、DBP、HR有差异(P<0.05);③两组SBP、DBP、HR变化趋势有差异(P<0.05)。两组术后1 h、6 h、12 h、24 h的Ramsay镇静评分比较,经重复测量设计的方差分析,结果:①不同时间点的Ramsay镇静评分有差异(P<0.05);②两组Ramsay镇静评分有差异(P<0.05);③两组Ramsay镇静评分变化趋势有差异(P<0.05)。两组术后10 min、30 min、3 h的PAED评分比较,经重复测量设计的方差分析,结果:①不同时间点间的PAED评分有差异(P<0.05);②GS组与GT组两组PAED评分有差异(P<0.05);③GS组与GT组PAED评分变化趋势有差异(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论GS、GT在小儿腹腔镜疝气手术中均有较高安全性,但GS更利于稳定血流动力学,促进早期苏醒,降低苏醒期躁动率。

Objective To analyze the effects of two anesthesia methods on hemodynamics and quality of recovery after the anesthesia in children undergoing laparoscopic hernia surgery.Methods The 140 children with inguinal hernia who underwent laparoscopic hernia surgery in Wuhu First People's Hospital from May 2016 to May 2021 were selected and randomly divided into GS group(general anesthesia combined with caudal block)and GT group(general anesthesia combined with transversus abdominis plane block),with 70 cases in each group.The quality of recovery,hemodynamics,Ramsay Sedation Scale score,Pediatric Anesthesia Emergence Delirium(PAED)score,and adverse reactions were compared between the two groups.Results The extubation time,the time to eye opening,and the time to recovery of consciousness in the GS group were shorter than those in the GT group(P<0.05).The systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)of GS group were compared with those of GT group at T0(before the induction of anesthesia),T1(immediately after the induction of anesthesia),T2(30 min after the induction of anesthesia),T3(the end of the operation),and T4(12 h after the operation),which exhibited that there were differences in SBP,DBP and HR at different time points(P<0.05)and between GS group and GT group(P<0.05),and that the change trend of SBP,DBP,and HR were different between the two groups(P<0.05).The Ramsay Sedation Scale scores at 1 h,6 h,12 h and 24 h after operation were compared was different between GS group and GT group,which showed that there were differences in Ramsay Sedation Scale scores at different time points(P<0.05)and between GS group and GT group(P<0.05),and that the change trends of the Ramsay Sedation Scale scores between the two groups(P<0.05).In addition,the PAED scores of GS group and GT group at 10 min,30 min and 3 h after operation were also compared,which suggested that there were differences in PAED scores at different time points(P<0.05)and between GS group and GT group(P<0.05),and that the change trend of the PAED scores is different between the two groups(P<0.05).However,there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions General anesthesia combined with caudal block or transversus abdominis plane block is safe in laparoscopic hernia surgery for children,but general anesthesia combined with caudal block is more conducive to stabilizing hemodynamics,promoting early recovery and reducing the incidence of emergence delirium.