不同镇痛方法在小儿腹腔镜手术中的应用比较

Comparison of different analgesic methods in laparoscopic surgery in children

目的研究不同镇痛方法在小儿腹腔镜手术中的应用比较。方法将2020年1月至2021年1月浙江省余姚市人民医院60例需择期行腹腔镜疝修补手术患儿按照随机数字表法分成两组,T组行全身麻醉气管插管+超声引导腹横肌平面阻滞术后镇痛,L组行全身麻醉气管插管+骶管阻滞术后镇痛。观察收集术后48 h内各时点小儿疼痛行为量表(FLACC)评分、Ramsay镇静评分、术后首次下床时间、术后肠道排气时间及不良反应发生率。结果术后4、8、12、24、48 h两组患儿FLACC及Ramsay评分比较,差异无统计学意义(P>0.05);T组患儿术后首次下床时间[(10.57±3.29)h]早于L组[(12.94±2.63)h],且T组术后肠道排气时间[(8.61±3.74)h]早于L组[(10.84±3.29)h],差异有统计学意义(P<0.05);两组患儿术后出现恶心呕吐的发生率比较,差异无统计学意义(P>0.05),而L组腹胀(26.67%)、尿潴留(16.67%)的发生率明显高于T组(6.67%、0),差异有统计学意义(P<0.05)。结论应用超声引导下腹横肌阻滞的腹腔镜手术小儿,术后镇痛良好,不良反应少,利于实现快速康复。

Objective To study the comparison of different analgesic methods in laparoscopic surgery in children.Methods A total of 60 children needing elective laparoscopic hernia repair in Yuyao People′s Hospital in Zhejiang Province from January 2020 to January 2021 were divided into two groups according to the random number table method.Postoperative analgesia was used in the T group with tracheal intubation general anesthesia+ultrasound guided transversus abdominis plain block,and in the L group with tracheal intubation general anesthesia+caudal block.The FLACC(facial expression,leg movement,activity,cry and consolability)behavioral pain assessment scale scores,Ramsay sedation scores,time to get out of bed for the first time,postoperative intestinal exhaust time and the incidences of adverse reactions at each time point within 48 hours after surgery were recorded.Results No statistically significant differences were observed in the FLACC and Ramsay scores between the two groups at 4 h,8 h,12 h,24 h and 48 h after surgery(P>0.05).The time of getting out of bed for the first time after surgery in the T group([10.57±3.29]h)was earlier than that in the L group([12.94±2.63]h);the postoperative intestinal exhaust time of the T group([8.61±3.74]h)was earlier than that of the L group([10.84±3.29]h);the differences were statistically significant(P<0.05).No statistically significant difference was observed in the incidence of postoperative nausea and vomiting between the two groups(P>0.05).The incidences of abdominal distension(26.67%)and urinary retention(16.67%)in the L group were significantly higher than those(6.67%,0)in the T group,with statistically significant differences(P<0.05).Conclusion Ultrasound guided laparoscopic transversus abdominis plane block in children has good postoperative analgesia and fewer adverse reactions,and is conducive to achieve rapid recovery.