全身麻醉复合骶管或腰方肌阻滞对腹腔镜手术围术期患儿效果观察

Perioperative effect of general anesthesia combined with caudal block or quadratus lumborum block in children undergoing laparoscopic surgery

目的探讨全身麻醉复合骶管阻滞或腰方肌阻滞对腹腔镜疝气手术患儿血流动力学及苏醒质量的影响。方法选取2022年3—6月本院收治的腹股沟疝患儿55例为研究对象,均行腹腔镜疝手术治疗,按随机数字表法分为对照组[G组,给予全身麻醉]17例、全身麻醉复合腰方肌阻滞组(GQ组)17例、全身麻醉复合骶管阻滞组(GC组)21例。记录患儿术后麻醉苏醒期躁动(PAED)评分和儿童疼痛行为量表(FLACC)评分,观察患儿麻醉开始前(T_(0))、麻醉开始时(T_(1))、手术结束时(T_(2))的血流动力学指标[平均动脉压(MAP)、心率(HR)和脉搏氧饱和度(SpO_(2))],并比较术中麻醉药总量、阿片类药物总量、手术时间、麻醉时间、拔除气管导管时间、住院时间、术后并发症发生情况等。结果与G组比较,GC组和GQ组各时点PAED评分差异有统计学意义(P<0.001);GC组和GQ组各时点的PAED评分比较,差异无统计学意义(P=1.000)。与G组比较,GC组和GQ组各时点FLACC评分差异有统计学意义(P<0.001);GC组和GQ组各时点FLACC评分比较,差异无统计学意义(P=0.572)。与G组比较,GC组、GQ组T_(1)和T_(2)时点的MAP和HR下降,差异有统计学意义(P<0.001)。与T_(0)时点比较,GC组、GQ组在T_(1)和T_(2)时点的MAP和HR均下降,而G组MAP和HR升高,差异有统计学意义(P<0.001)。与G组比较,GC组、GQ组术中丙泊酚总量、顺式阿曲库胺总量、芬太尼总量、瑞芬太尼总量减少,但差异无统计学意义(P=0.166、0.091、0.100、0.402)。GC组、GQ组麻醉时间较G组长,拔管时间较G组短,差异有统计学意义(P<0.001)。结论骶管阻滞、腰方肌阻滞在小儿腹腔镜内环口缝扎手术中均有较高安全性,更利于血流动力学稳定,促进早期苏醒,降低苏醒期躁动率。

Objective To investigate the effects of general anesthesia combined with caudal block or quadratus lumborum block on hemodynamics and recovery quality in children undergoing laparoscopic hernia surgery.Methods Fifty-five children with inguinal hernia treated in our hospital from March to June 2022 were selected,and were performed laparoscopic hernia surgery.They were randomly divided into three groups:control group(G group,given general anesthesia,n=17),general anesthesia combined with quadratus lumborum block group(GQ group,n=17)and general anesthesia combined with caudal block group(GC group,n=21).The scores of Pediatric Anesthesia Emergence Delirium(PAED)and Faces,Legs,Activity,Cry,and Consolability(FLACC)were recorded,hemodynamic parameters including mean arterial pressure(MAP),heart rate(HR),and pulse blood oxygen saturation(SpO_(2))before anesthesia(T_(0)),at the beginning of anesthesia(T_(1))and at the end of operation(T_(2))were observed,and the total amount of anesthetics and opioids during operation,operation time,anesthesia time,extubation time of tracheal catheter,hospital stay and occurrence of postoperative complications were recorded.Results Compared with G group,PAED scores of GC group and GQ group at difference time pointswere showed significant difference(P<0.001).There was no significant difference in PAED scores between GC group and GQ group at each time point(P=1.000).Compared with G group,FLACC score of GC group and GQ group at each time point showed a significant difference(P<0.001),and there was no significant difference in FLACC score between GC group and GQ group at each time point(P=0.572).Compared with group G,MAP and HR in GC and GQ groups decreased at T_(1) and T_(2)(P<0.001).Compared with T_(0),MAP and HR in GC and GQ groups decreased at T_(1) and T_(2),while were increased in the G group(P<0.001).Compared with the G group,the total amount of propofol,cisatracurium,fentanyl and remifentanil in GC and GQ groups decreased,but the difference was not statistically significant(P=0.166,0.091,0.100,0.402).The anesthesia time of GC and GQ groups was longer than that of the G group,while the extubation time was shorter than that of the G group(P<0.001).Conclusion Caudal block and quadratus lumborum block have higher safety in laparoscopic internal ring suture surgery in children,which can maintain hemodynamic stability,promote early recovery and reduce the restlessness rate of recovery period.