超声引导下双侧腹横肌平面阻滞在小儿腹腔镜手术围术期的镇痛效果观察

Observation on analgesic effect of ultrasound-guided bilateral transversus abdominis plane block in the perioperative period of pediatric laparoscopic surgery

目的 评价超声引导下双侧腹横肌平面阻滞(TAPB)在小儿腹腔镜手术(小儿腹腔镜疝修补术和鞘状突高位结扎术)围术期的镇痛效果。方法 64例择期行腹腔镜疝修补术和鞘状突高位结扎术的患儿,采用随机数字表法分为观察组和对照组,每组32例。观察组予以超声引导下双侧TAPB,对照组不予神经阻滞。比较两组患儿围术期各指标[手术时间、麻醉恢复室(PACU)留观时间、术中瑞芬太尼用量、术后恶心呕吐(PONV)、苏醒期躁动],各时点[切皮即刻、术后1 h(T1)、术后3 h(T2)、术后6 h(T3)、术后8 h(T4)]心率(HR)、平均动脉压(MAP)水平,术后不同时点儿童疼痛行为量表(FLACC)评分。结果 两组手术时间、PACU留观时间比较差异无统计学意义(P>0.05);观察组术中瑞芬太尼用量(210±11)μg少于对照组的(319±8)μg, PONV发生率3%和苏醒期躁动发生率6%均低于对照组的19%、38%,差异有统计学意义(P<0.05)。观察组切皮即刻、T2、T3时HR分别为(109±4)、(95±7)、(91±3)次/min, MAP分别为(79±3)、(73±5)、(70±3)mm Hg(1 mm Hg=0.133 kPa);对照组切皮即刻、T2、T3时HR分别为(123±3)、(123±6)、(115±4)次/min, MAP分别为(86±5)、(82±4)、(84±3)mm Hg;观察组切皮即刻、T2、T3时HR、MAP水平均低于对照组,差异有统计学意义(P<0.05);两组T1、T4时HR、MAP水平比较差异无统计学意义(P>0.05)。观察组T1、T2、T3、T4时的FLACC评分分别为(1.3±0.2)、(1.3±0.4)、(1.0±0.2)、(0.3±0.1)分,均低于对照组的(3.0±0.1)、(4.1±0.6)、(2.9±0.2)、(1.1±0.5)分,差异有统计学意义(P<0.05)。结论 超声引导下双侧TAPB在小儿腹腔镜手术(小儿腹腔镜疝修补术和鞘状突高位结扎术)中安全且围术期镇痛效果好,减少了镇痛药物的使用量,提高了苏醒质量。

Objective To evaluate the analgesic effect of ultrasound-guided bilateral transversus abdominis plane block(TAPB)in the perioperative period of pediatric laparoscopic surgery(laparoscopic hernia repair and high ligation of processus vaginalis).Methods A total of 64 children who underwent laparoscopic hernia repair and high ligation of processus vaginalis were divided into observation group and control group according to the random numerical table,with 32 cases in each group.The observation group received ultrasoundguided bilateral TAPB,and the control group received no nerve block.Both groups were compared in terms of perioperative indexes[operative time,post-anesthesia care unit(PACU)time,intraoperative dosage of remifentanil,postoperative nausea and vomiting(PONV),emergence agitation],heart rate(HR)and mean arterial pressure(MAP)at different time points[immediately after incision,1 h after surgery(T1),3 h after surgery(T2),6 h after surgery(T3),8 h after surgery(T4)],and face,legs,activity,crying,consolability scale(FLACC)scores at different time points after surgery.Results There was no statistically significant difference in operative time and PACU time between the two groups(P>0.05).The intraoperative dosage of remifentanil of(210±11)μg in the observation group was lower than that of(319±8)μg in the control group;the incidence of PONV and emergence agitation were 3%and 6%in the observation group,which were lower than those of 19%and 38%in the control group;the differences were statistically significant(P<0.05).In the observation group,HR were(109±4),(95±7)and(91±3)beats/min immediately after incision,at T2 and T3,and MAP were(79±3),(73±5)and(70±3)mm Hg(1 mm Hg=0.133 kPa),respectively.In control group,HR were(123±3),(123±6),(115±4)beats/min immediately after incision,at T2 and T3,and MAP were(86±5),(82±4),(84±3)mm Hg,respectively.HR and MAP levels in the observation group were lower than those in the control group immediately after incision,at T2 and T3,and the differences were statistically significant(P<0.05).There was no statistically significant difference in HR and MAP levels at T1 and T4 between the two groups(P>0.05).FLACC scores were(1.3±0.2),(1.3±0.4),(1.0±0.2)and(0.3±0.1)points in the observation group at T1,T2,T3 and T4,which were lower than those of(3.0±0.1),(4.1±0.6),(2.9±0.2)and(1.1±0.5)points in the control group,and the differences were statistically significant(P<0.05).Conclusion Ultrasound-guided bilateral TAPB is safe and effective for perioperative analgesia in pediatric laparoscopic surgery(laparoscopic hernia repair and high ligation of processus vaginalis),and can reduce the use of analgesic drugs and improve the quality of awakening.