全麻复合骶管阻滞在Swenson手术治疗HD患儿中的应用价值

Application value of general anesthesia combined with sacral canal block in Swenson operation on children with Hirschsprung's disease

目的探讨全麻复合骶管阻滞在斯文森手术治疗先天性巨结肠患儿中的应用价值。方法将92例拟接受Swenson手术治疗的先天性巨结肠患儿采用随机数字表分为复合麻醉组(全麻复合骶管阻滞麻醉方式)和全麻组(气管插管全麻),各46例。监测并比较两组患儿血流动力学参数、麻醉用药情况、苏醒指标、不良反应及手术前后外周血T淋巴细胞、应激反应指标。结果复合麻醉组气腹5 min、气腹20 min和术毕收缩压值均显著低于全麻组(P<0.01),气腹5 min和气腹20 min舒张压、心率值显著低于全麻组(P<0.05或0.01)。复合麻醉组顺阿曲库铵、舒芬太尼、异丙酚剂量显著少于全麻组(P<0.01),苏醒时间、呼吸睁眼时间、自主呼吸恢复时间显著短于全麻组(P<0.01)。术后24 h复合麻醉组CD3+、CD4+和CD4+/CD8+显著高于全麻组(P<0.05或0.01),去甲肾上腺素、肾上腺素水平显著低于全麻组(P<0.01)。结论全麻复合骶管阻滞在Swenson手术治疗先天性巨结肠患儿中麻醉效果较好,可减少麻醉药物用量,对血流动力学、免疫功能影响较小,能减轻机体应激反应程度。

Objective To explore the application value of general anesthesia combined with sacral canal block(GACSCB)in Swenson operation on children with Hirschsprung's disease(HD).Methods Ninety-two HD children undergoing Swenson surgery were assigned to combined anesthesia group(GACSCB,n=46)and general anesthesia group(tracheal intubation general anesthesia,n=46)according to random number table.Such indexes were detected and compared between two groups as hemodynamic parameters,anesthetic drugs,recovery indicators,adverse reactions as well as pre-and post-operation peripheral blood T lymphocytes,and stress response.Results Pneumoperitoneum 5 min,20 min and postoperative systolic pressure were all significantly lower in combined anesthesia than in general anesthesia group(P<0.01),so were 5 min,20min diastolic pressure and heart rate(P<0.05 or 0.01).Dosages of atracurium,sufentanil and propofol were significantly lower in combined anesthesia than in general anesthesia group(P<0.01),recovery,respiration and eye-opening,and spontaneous breathing recovery time significantly quicker(P<0.01).Postoperative 24 h CD3+,CD4+,CD4+/CD8+levels were significantly higher in combined anesthesia than in general anesthesia group(P<0.05 or 0.01),noradrenaline and epinephrine A lower(P<0.01).Conclusion The GACSCB applied in Swenson surgery on congenital HD children has better anesthetic effect,could reduce dosages of anaesthetics,has less impact on hemodynamics and immunologic function,and could alleviate organic stress response.