超声引导下骶管阻滞在小儿腹腔镜下腹股沟疝手术中的应用

Application of ultrasound-guided sacral canal block in laparoscopic inguinal hernia surgery in children

目的探讨骶管阻滞在小儿腹腔镜疝气手术中的作用。方法选取2020年1—10月六安市人民医院择期行腹股沟疝修补术患儿90例,美国麻醉医师协会分级Ⅰ~Ⅱ级,年龄1~8岁,采用随机数字表法分为对照组(C组)和骶管组(D组),每组45例,D组在全麻插管后进行骶管穿刺,穿刺成功后均注射0.2%罗哌卡因1 mL/kg,C组不行骶管阻滞。同时对2组患儿进行麻醉深度监测Narcotrend指数维持在C2~D1(69~47),记录2组患儿麻醉前、骶管阻滞后5 min、手术开始时、手术结束时、拔管时的心率(HR)、平均动脉压(MAP),拔管时、术后4、8、12、16及24 h婴幼儿疼痛评分(FLACC),患儿术后躁动评分及躁动发生率,恶心呕吐、尿潴留等不良反应的发生情况。结果与C组比较,D组患儿术后在拔管时[(3.75±0.71)分vs.(5.84±0.97)分]、术后4 h[(3.02±0.50)分vs.(4.88±0.71)分]、8 h[(2.91±0.36)分vs.(4.53±0.75)分]时的FLACC疼痛评分明显低于C组(均P<0.05);苏醒时躁动评分[(2.44±0.54)分]明显低于C组[(3.29±0.69)分],躁动发生率(6.67%)低于C组(22.22%,均P<0.05);2组患儿一般情况、手术时间、苏醒时间、心率、MAP以及术后不良反应发生率差异无统计学意义(均P>0.05)。结论骶管阻滞可以有效减少苏醒期躁动的发生,具有良好的镇痛效果,加快术后康复。

Objective To investigate the role of sacral canal blocks in paediatric laparoscopic hernia surgery.Methods Ninety children(American Society of Anesthesiologist gradeⅠ-Ⅱ,aged 1-8 years old)undergoing elective inguinal hernia repair in Lu'an people's hospital were divided into the control group(group C)and sacral canal group(D)by random number table method,with 45 cases in each group.Group D underwent sacral canal puncture after general anaesthesia intubation,and all patients were injected with 1 mL/kg of 0.2%ropivacaine after successful puncture,whereas group C did not have sacral canal block.The Narcotrend index(NI)was maintained at C2-D1(69-47)for both groups.The heart rate(HR)and mean arterial pressure(MAP)of children in both groups were evaluated before anaesthesia,5 min after sacral block,at the beginning of surgery,at the end of surgery and at extubation.The children's face legs activity crying consolability(FLACC)scores were recorded at the time of extubation and 4,8,12,16 and 24 h postoperatively.The postoperative agitation score,agitation incidence,nausea,vomiting and urinary retention was recorded.Results The FLACC pain scores of children in group D at tube drawing time[(3.75±0.71)points vs.(5.84±0.97)points],4 h after operation[(3.02±0.50)points vs.(4.88±0.71)points]and 8 h after operation[(2.91±0.36)points vs.(4.53±0.75)points]were significantly lower than those in group C(all P<0.05).When the children in group D woke up,their agitation score(2.44±0.54)and agitation incidence(6.67%)were significantly lower than those in group C[(3.29±0.69)points and 22.22%,all P<0.05].There was no statistical significance in general situation,operation time,waking time,HR,MAP and postoperative adverse reaction incidence between the two groups of children(all P>0.05).Conclusion Sacral canal block can effectively reduce the incidence of waking agitation,which has excellent postoperative pain relief and can accelerate recovery after operation.