超声引导下腹横肌平面阻滞对腹腔镜腹股沟疝手术儿童苏醒躁动及应激反应的影响

Effect of ultrasound-guided transversus abdominis plane block applied in pediatric laparoscopic inguinal hernia surgery on awaking agitation and stress response

目的探究超声引导下腹横肌平面(TAP)阻滞对儿童腹腔镜下腹股沟疝手术的效果,以及对患儿苏醒躁动及应激反应的影响。方法选取2019年10月至2020年12月在湖北省汉川市人民医院接受治疗的腹股沟疝患儿82例,采用随机数表法分为观察组(42例)和对照组(40例)。在进行常规全身麻醉诱导后,观察组患儿在超声引导下注射0.25%盐酸罗哌卡因行双侧TAP阻滞,而对照组患儿在相同部位注射等量的氯化钠溶液。结果2组患儿的一般资料比较,差异无统计学意义(P>0.05);术后睁眼时间以及清醒时间比较,差异均无统计学意义(P>0.05)。观察组患儿的躁动发生率、丙泊酚、芬太尼使用量均低于对照组(均P<0.05);建立气腹即刻、20 min、40 min时,观察组患儿的血浆皮质醇、血糖浓度、收缩压及舒张压均低于对照组(均P<0.05)。结论TAP阻滞可显著降低腹股沟疝手术患儿应激反应,维持其血流动力学稳定,降低其镇痛药物的使用以及躁动发生率。

Objective The purpose of this study was to explore the effect of ultrasound-guided transversus abdominis plane(TAP)block on pediatric laparoscopic inguinal hernia surgery,and the influence on awaking agitation and stress response in children.Methods 82 children with inguinal hernia treated in the hospital were enrolled in this study between October 2019 and December 2020.They were divided into observation group(42 cases)and control group(40 cases)by random number table method.After induction of conventional general anesthesia,children in the observation group were injected with 0.25%ropivacaine hydrochloride under the guidance of ultrasound for bilateral TAP block,while children in the control group were injected with the same amount of sodium chloride solution at the same site.Results The general data,postoperative eye opening time and awake time of the two groups showed no significant differences(P>0.05).The incidence of agitation and the amount of propofol and fentanyl used in the observation group were lower than those in the control group(P<0.05).The plasma cortisol(Cor)and glucose(Glu)levels,systolic blood pressure(SBP)and diastolic blood pressure(DBP)of the observation group immediately after pneumoperitoneum,at 20 and 40 minutes were lower than those of the control group(P<0.05).Conclusion TAP block can significantly reduce stress response,maintain hemodynamic stability,reduce the use of analgesics and the incidence of analgesics,and alleviate postoperative pain in children undergoing inguinal hernia surgery,which is worth promotion in clinical practice.