超声引导下腹直肌鞘阻滞联合SLIPA喉罩在小儿腹腔镜手术中的应用

Effect of rectus sheath block combined with SLIPA laryngeal mask in pediatric laparoscopic surgery

目的探讨超声引导下腹直肌鞘阻滞联合SLIPA喉罩在小儿腹腔镜手术中的应用效果。方法选取全麻下行腹腔镜手术的患儿120例,随机分为超声引导下腹直肌鞘阻滞联合SLIPA喉罩组(试验组)及SLIPA喉罩组(对照组),每组60例。对比两组患儿不同时间点的平均动脉压、心率、血浆皮质醇及血糖水平;对比两组丙泊酚、瑞芬太尼用量,苏醒时间,躁动及不良反应等情况。结果术后试验组的心率及平均动脉压均低于对照组(P<0.05);术中及术后试验组血浆皮质醇及血糖水平均低于对照组(P<0.05);试验组苏醒时间、瑞芬太尼用量、苏醒期躁动以及术后疼痛均小于对照组(P<0.05);两组术后疼痛差与血糖及皮质醇差值相关(P<0.05);两组不良反应发生率差异无统计学意义(P>0.05)。结论腹直肌鞘阻滞联合SLIPA喉罩麻醉能安全有效应用于小儿腹腔镜手术,并具有使用阿片类药物少、苏醒快、术后疼痛轻及围手术期应激水平低的优点。

Objective To explore the effect of ultra-sound guided rectus sheath block(RSB)combined with SLIPA laryngeal mask in pediatric laparoscopic surgery.Methods A total of 120 chilren undergoing laparoscopic surgery under general anesthesia were randomly divided into ultra-sound guided RSB combined with SLIPA laryngeal mask group(experimental group)and SLIPA mask group(control group),with 60 cases in each group.The mean arterial pressure,heart rate,plasma cortisol and blood glucose level were compared between the two groups at different time points.The usage of propofol and remifentanil,the recovery time,agitation and adverse reactions were compared between the two groups.Results The mean arterial pressure and heart rate of experimental group were lower than those of control group after operation(P<0.05).The levels of plasma cortisol and blood glucose of experimental group were lower than those of control group during and after operation(P<0.05).The recovery time,usage of remifentanil and agitation rate during recovery and postoperative pain of experimental group were all lower than those of control group(P<0.05).The difference of postoperative pain between the two groups was correlated with the difference of blood glucose and cortisol(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion The ultra-sound guided RSB combined with SLIPA laryngeal mask airway anesthesia could be safely and effectively used in pediatric laparoscopic surgery.It has the advantages of less use of opioids,faster recovery,milder postoperative pain and lower perioperative stress.