超声引导下腹横筋膜阻滞在小儿先天性肾盂输尿管连接部梗阻手术中的麻醉效果分析

Analysis of anesthesia effect of ultrasound-guided abdominal transverse fascial block in the surgery for congenital obstruction of the ureteropelvic junction of children

目的:探讨超声引导下腹横筋膜阻滞在小儿先天性肾盂输尿管连接部梗阻术中的麻醉效果。方法:选择医院确诊并行腹腔镜手术治疗的125例先天性肾盂输尿管连接部梗阻患儿,采用随机抽签法将其分为观察组(62例)和对照组(63例),对照组给予全身麻醉,观察组在对照组全身麻醉基础上给予超声引导下腹横筋膜阻滞。观察并记录两组患儿术后苏醒时间、苏醒期躁动及并发症发生情况,以及神经阻滞后(T2)、气腹建立(T3)、气腹撤退(T4)及手术结束(T5)时的不同时间点平均动脉压(MAP)、心率(HR)水平以及视觉模拟疼痛量表(VAS)评分情况。结果:观察组患儿苏醒时间明显短于对照组,差异有统计学意义(t=19.652,P<0.05),苏醒期躁动占比明显低于对照组,差异有统计学意义(x^(2)=6.305,P<0.05)。观察组MAP和HR水平在T2、T3、T4和T5时的不同时间点均明显高于对照组,差异有统计学意义(tMAP=2.104,t=4.200,t=4.256,t=4.547:tHR=3.774,t=4.709,t=5.710,t=7.989;P<0.05)。两组患儿术后4 h、12 h、24 h和48 h时的VAS评分随着时间的推移先升高后降低,且观察组患儿术后4 h、12 h及24 h时VAS评分均明显低于对照组,差异有统计学意义(t=6.245,t=13.593,t=14.501;P<0.05)。观察组患儿术后并发症发生率(6.45%)与对照组患儿术后并发症发生率(15.87%)比较,差异无统计学差异(x^(2)=2.789,P>0.05)。结论:超声引导下腹横筋膜阻滞在小儿先天性肾盂输尿管连接部梗阻术中的麻醉效果较好,不仅能够有效缩短患儿苏醒时间,降低苏醒期躁动发生率,对血流动力学稳定性更好,可有效缓解术后疼痛。

Objective:To explore the anesthesia effect of ultrasound-guided abdominal transverse fascia block in congenital obstruction of ureteropelvic junction of children.Methods:A total of 125 pediatric patients with congenital obstruction of the ureteropelvic junction who were confirmed and underwent laparoscopic surgery in hospital were selected as the research subjects.They were divided into the study group(62 cases)and the control group(63 cases)by random drawing.The cases in the control group received general anesthesia,and the cases in the study group received ultrasound-guided abdominal transverse fascia block on the basis of the control group.The wake-up time,dysphoria during wake-up period and postoperative complications,as well as the mean arterial pressure(MAP)values,heart rate(HR)levels,and visual analogue scale(VAS)values at different time points included post nerve block(T2),establishing pneumoperitoneum(T3),pneumoperitoneum retreating(T4)and completing surgery(T5),of two groups were observed and recorded.Results:The wake-up time of the study group was significantly shorter than that of the control group(t=19.652,P<0.05),and the proportion of dysphoria during the wake-up period was significantly lower than that of the control group(x^(2)=6.305,P<0.05).The levels of MAP and HR in the study group were significantly higher than those in the control group at T2,T3,T4 and T5,respectively,and the differences were statistically significant(tMAP=2.104,t=4.200,t=4.256,t=4.547,tHR=3.774,t=4.709,t=5.710,t=7.989,P<0.05),respectively.The VAS scores of the two groups at 4h,12h,24h and 48h after operation increased first and then decreased as time went on,and the VAS scores of the study group were significantly lower than those of the control group at 4h,12h and 24h after operation,the differences were statistically significant(t=6.245,t=13.593,t=14.501,P<0.05),respectively.There was no significant difference in the incidence of postoperative complications between the study group(6.45%)and the control group(15.87%)(x^(2)=2.789,P>0.05).Conclusion:The ultrasound-guided abdominal transverse fascial block has a better anesthesia effect in surgery for congenital obstruction of the ureteropelvic junction of children,which can not only effectively shorten the wake-up time of pediatric patients,and reduce the incidence of dysphoria during wake-up period,but also is better for the hemodynamic stability.It can effectively relieve postoperative pain.