喉罩全身麻醉复合骶管阻滞对尿道下裂患儿术中血流动力学及术后苏醒时间的影响

Effects of laryngeal mask anesthesia combined with sacral block on intraoperative hemodynamics and postoperative recovery time in children with hypospadias

目的探究喉罩全身麻醉复合骶管阻滞对尿道下裂患儿术中血流动力学及术后苏醒时间的影响。方法选取2021年1月至2023年1月我院收治的82例行手术治疗的尿道下裂患儿作为研究对象,按照随机数字表法按1∶1比例分为A组、B组,各41例。B组采用喉罩全身麻醉,A组采用喉罩全身麻醉复合骶管阻滞。比较两组术中瑞芬太尼用量、丙泊酚用量、术后苏醒时间、麻醉前(T 0)、喉罩置入时(T 1)、切皮时(T 2)、手术30 min(T 3)、拔除喉罩时(T 4)血流动力学[心率(HR)、平均动脉压(MAP)]、麻醉苏醒期小儿麻醉苏醒期躁动量化评分(PAED)、术前、术后12 h应激指标[去甲肾上腺素(NE)、皮质醇(Cor)]及免疫功能(CD3+、CD4+、CD8+)。结果A组术后苏醒时间较B组短,瑞芬太尼、丙泊酚用量较B组少(P<0.05);T 1、T 2、T 3、T 4时刻A组HR、MAP较B组低,且T 0~T 4时刻A组MAP、HR波动幅度较B组小(P<0.05);A组PAED评分较B组低(P<0.05);术后12 h A组血清NE、Cor水平较B组低(P<0.05);术后12 h A组CD3+、CD4+水平较B组高,CD8+水平较B组低(P<0.05)。结论罩全身麻醉复合骶管阻滞应用于尿道下裂患儿麻醉效果较好,可维持术中血流动力学稳定,减少麻醉药物用量,预防苏醒期躁动,减轻术后应激反应,且对免疫功能影响较小。

Objective To investigate the effect of laryngeal mask anesthesia combined with sacral block on intraoperative hemodynamics and postoperative recovery time of children with hypospadias.Methods A total of 82 children with hypospadias who underwent surgical treatment in our hospital from January 2021 to January 2023 were selected as research objects and divided into group A and Group B with 41 cases in each group according to the random number table method in a 1∶1 ratio.Group B received laryngeal mask general anesthesia,group A received laryngeal mask general anesthesia combined with sacral canal block.The intraoperative dosage of remifentanil,propofol,postoperative recovery time,pre-anesthesia(T 0),laryngeal mask placement(T 1),cuticle resection(T 2),operation 30 were compared between the two groups min(T 3),hemodynamics[heart rate(HR),mean arterial pressure(MAP)]during laryngeal mask removal(T 4),quantified score of agitation during anesthesia recovery(PAED),preoperative and postoperative 12 h stress index[norepinephrine(NE),cortisol(Cor)]and immune function(CD3+,CD4+,CD8+).Results The postoperative recovery time of group A was shorter than that of group B,and the dosage of remifentanil and propofol was less than that of group B(P<0.05).HR and MAP in group A at T 1,T 2,T 3 and T4 were lower than those in group B,and the fluctuation range of MAP and HR in group A at T0 to T4 was smaller than that in group B(P<0.05).PAED score of group A was lower than that of group B(P<0.05).The serum levels of NE and Cor in 12 h A group were lower than those in B group(P<0.05).The levels of CD3+and CD4+in 12 h A group were higher than those in B group,and the levels of CD8+were lower than those in B group(P<0.05).Conclusion Laryngeal mask general anesthesia combined with sacral block has a good anesthetic effect in children with hypospadias,which can maintain the stability of intraoperative hemodynamics,reduce the dosage of anesthetic drugs,prevent agitation during recovery,reduce postoperative stress response,and have little effect on immune function.