超声引导下侧路联合髂腹下/髂腹股沟腹横肌平面两点阻滞在腹腔镜腹股沟疝修补术中的应用

Application of ultrasound-guided lateral approach combined with iliohypogastric/ilioinguinal TAP two-point block in laparoscopic inguinal hernia repair

目的探讨超声引导下侧路联合髂腹下/髂腹股沟腹横肌平面(transversus abdominis plane,TAP)两点阻滞在腹腔镜腹股沟疝修补术中的应用效果。方法2021年1月~2022年4月我院行单侧腹腔镜腹股沟疝修补术的病人88例,根据随机数字表法将病人分为观察组和对照组,每组各44例,对照组在全身麻醉后采用侧路TAP阻滞,观察组在全身麻醉后采用侧路联合髂腹下/髂腹股沟TAP两点阻滞。比较两组病人在切皮时(T_(1))、术后3小时(T_(2))、术后6小时(T_(3))、术后12小时(T_(4))、术后24小时(T_(5))等5个时间点的心率和平均动脉压波动率,采用视觉模拟评分法(visual analogue scale,VAS)比较两组病人在T_(2)~T_(5)时的疼痛程度,比较两组病人麻醉效果满意度。结果两组病人均顺利完成手术,观察组在T_(2)~T_(4)静息时VAS评分分别为(2.04±0.55)、(2.41±0.57)和(2.95±0.70)分,活动时VAS评分分别为(2.82±0.59)、(3.16±0.68)和(3.80±0.77)分,对照组在T_(2)~T_(4)静息时VAS评分分别为(2.32±0.69)、(3.29±0.77)和(3.54±1.08)分,活动时VAS评分分别为(3.55±0.83)、(4.07±0.91)和(4.34±1.05)分,观察组VAS评分低于对照组,静息时VAS≥4分的比例更低(20.45%VS.47.73%),在T_(2)~T_(5)时观察组血流动力学更加平稳,麻醉效果满意度显著好于对照组(93.18%VS.70.45%),差异均有统计学意义(P<0.05)。结论在腹腔镜腹股沟疝修补术中采用TAP两点阻滞,术后镇痛效果好,血流动力学平稳,麻醉效果优于侧路TAP阻滞。

Objective To explore the effect of application of ultrasound-guided lateral approach combined with iliohypogastric/ilioinguinal transversus abdominis plane(TAP)two-point block in laparoscopic inguinal hernia repair.Methods 88 patients who underwent unilateral inguinal hernia repair in our hospital from January 2021 to April 2022 were enrolled as the study subjects.The patients were divided into observation group(n=44)and control group(n=44)according to the random number table.In the control group,lateral TAP block was used after general anesthesia,and in the observation group,lateral combined iliohypogastric/ilioinguinal TAP two-point block was used after general anesthesia.The volatility of heart rate and mean arterial pressure were analyzed and compared between the two groups at five time points:skin incision(T_(1)),3 hours after surgery(T_(2)),6 hours after surgery(T_(3)),12 hours after surgery(T_(4)),and 24 hours after surgery(T_(5)),and visual analogue scale(VAS)scores were used to compare the degree of pain at T_(2)-T_(5) between the two groups,and the satisfaction of anesthetic effect was compared between the two groups.Results The two groups of patients were successfully completed the operation.In the observation group,the VAS scores at rest at T_(2)-T_(4) were(2.04±0.55),(2.41±0.57)and(2.95±0.70)points,the VAS scores at activity were(2.82±0.59),(3.16±0.68)and(3.80±0.77)points,in the control group,the VAS scores at rest were(2.32±0.69),(3.29±0.77)and(3.54±1.08)points,and(3.55±0.83),(4.07±0.91)and(4.34±1.05)points at activity,respectively.The VAS scores in the observation group were significantly lower than those in the control group,and the proportion of VAS≥4 points at rest was lower(20.45%VS.47.73%).At T_(2)-T_(5),the hemodynamics in the observation group were more stable,and the satisfaction rate of anesthetic effect was significantly better than that in the control group(93.18%VS.70.45%),and the above differences were statistically significant(P<0.05).Conclusion In laparoscopic inguinal hernia repair,the use of TAP two-point block anesthesia has better postoperative analgesia,more stable hemodynamics,and better anesthesia than lateral TAP block.