区域麻醉镇静下超声引导双腹横肌平面阻滞在老年单侧腹股沟疝患者中的应用效果

Application Effects of Ultrasound-Guided Double Transversus Abdominis Plane Block Under Regional Anesthesia Sedation in Elderly Patients with Unilateral Inguinal Hernia

目的探讨区域麻醉(RA)镇静下超声引导双腹横肌平面阻滞(TAPB)麻醉对老年单侧腹股沟疝(IH)患者各时间点平均动脉压(MAP)、心率(HR)、创伤应激因子、术后视觉模拟评分(VAS)的影响。方法选取2019年1月至2021年3月商丘市睢阳区中医院收治的82例单侧IH老年患者作为研究对象。根据采取的麻醉方案分成观察组(41例)和对照组(41例)。两组患者均接受IH修补术治疗。对照组患者接受局部浸润麻醉(LIA),观察组患者接受RA镇静下的超声引导双TAPB麻醉。对比两组患者不同时间点[T_(1)(麻醉开始前)、T_(2)(切皮时)、T_(3)(腹外斜肌腱膜打开时)、T_(4)(剥离疝囊时)、T_(5)(补片缝合时)、T_(6)(腹外斜肌筋膜缝合时)、T_(7)(切口关闭时)]的HR、MAP水平变化,术后2、4、6、12 h VAS评分,T_(1)、T_(7)及术后12 h血清皮质醇(Cor)、血管紧张素(AngⅡ)水平。结果观察组T_(2)~T_(7)时刻HR、MAP水平较对照组降低(P<0.05);观察组术后2、4、6、12 h的VAS评分较对照组降低(P<0.05);观察组T_(1)、T_(7)及术后12 h的血清Cor、AngⅡ水平较对照组降低(P<0.05)。结论应用RA镇静下超声引导双TAPB对单侧IH老年患者各时间点HR、MAP的影响较小,可有效减轻患者术后疼痛感,减轻机体应激反应,值得在单侧IH老年手术患者中推广使用。

Objective To investigate the effect of ultrasound-guided double transversus abdominis plane block(TAPB)under regional anesthesia(RA)sedation on mean arterial pressure(MAP),heart rate(HR),traumatic stress factors and visual analogue scale(VAS)at each time point in elderly patients with unilateral inguinal hernia(IH).Methods A total of 82 patients with unilateral IH in Suiyang District Hospital of Traditional Chinese Medicine of Shangqiu from January 2019 to March 2021 were selected as research objects and they were divided into observation group(41 cases)and control group(41 cases)according to the anesthesia schemes.Patients in both groups received IH repair,patients in the control group received local infiltration anesthesia(LIA),and patients in the observation group received ultrasound-guided double TAPB anesthesia under RA sedation.The levels of HR and MAP at different time points[T_(1)(before anesthesia),T_(2)(during skin incision),T_(3)(when the external oblique muscle fascia opened),T_(4)(when the hernia sac stripped),T_(5)(when the patch sutured),T_(6)(when the external oblique muscle fascia sutured at time)and T_(7)(when the incision closed)],VAS scores at 2,4,6 and 12 hours after operation,serum levels of cortisol(Cor)and angiotensin(AngⅡ)at T_(1),T_(7) and 12 hours after operation were compared between observation group and control group.Results The levels of HR and MAP in the observation group were lower than those in the control group from T_(2) to T_(7)(P<0.05).The VAS scores in the observation group at 2,4,6 and 12 hours after operation were lower than those in the control group(P<0.05).The serum levels of Cor and AngⅡat T_(1),T_(7) and 12 hours after operation were lower than those in the control group(P<0.05).Conclusion Ultrasound-guided double TAPB under RA sedation has little effect on HR and MAP at each time point in elderly patients with unilateral IH,and can effectively relieve postoperative pain and body stress response,which is worthy of extension in elderly patients with unilateral IH.