蛛网膜下腔阻滞与超声引导下腹横肌平面阻滞在老年腹股沟疝修补术中的应用效果比较

Comparison of application effects of subarachnoid block and ultrasound-guided transverse abdominis plane block in inguinal hernia repair in the elderly

目的比较蛛网膜下腔阻滞与超声引导下腹横肌平面阻滞(TAPB)在老年腹股沟疝修补术中的应用效果。方法选择2020年1月至2021年12月于本院择期行单侧腹股沟疝修补术的70例老年患者为研究对象,根据麻醉方法的不同将其分为T组(超声引导下TAPB)和S组(蛛网膜下腔阻滞),每组35例。比较两组的麻醉效果。结果T组的完成阻滞所需时间、达到最高感觉阻滞平面麻醉时间明显长于S组(P<0.05);T组的最高感觉阻滞平面低于S组(P<0.05)。T组的不良事件总发生率低于S组(P<0.05)。T组不同时间点的心率(HR)及平均动脉压(MAP)比较,差异无统计学意义(P>0.05);S组不同时间点的HR及MAP比较,差异具有统计学意义(P<0.05)。术后3、6、12、24、48 h,T组的视觉模拟评估法(VAS)评分均低于S组(P<0.05);T组的术后镇痛时间长于S组(P<0.05)。结论与蛛网膜下腔阻滞相比,超声引导下TAPB可为老年腹股沟疝修补术患者提供更好的术中血流动力学管理和术后镇痛效果,且不良事件发生率较低。

Objective To compare the application effects of subarachnoid block and ultrasound-guided transverse abdominis plane block(TAPB)in inguinal hernia repair in the elderly.Methods From January 2020 to December 2021,70 elderly patients undergoing elective unilateral inguinal hernia repair in our hospital were selected as the research objects.According to different anesthesia methods,the patients were divided into group T(ultrasound-guided TAPB)and group S(subarachnoid block),with 35 cases in each group.The anesthetic effects of the two groups were compared.Results The time required to complete blockage and the anesthesia time to reach the highest sensory block plane in the group T were significantly longer than those in the group S(P<0.05);the highest sensory block level in the group T was lower than that in the group S(P<0.05).The total incidence of adverse events in the group T was lower than that in the group S(P<0.05).There were no significant differences of heart rate(HR)and mean arterial pressure(MAP)at different time points in the group T(P>0.05);there were statistically significant differences of HR and MAP at different time points in the group S(P<0.05).At 3,6,12,24,48 h after operation,the Visual Analogue Scale(VAS)score of the group T was lower than that of the group S(P<0.05);the postoperative analgesia time of the group T was longer than that of the group S(P<0.05).Conclusion Compared with subarachnoid block,ultrasound-guided TAPB can provide better intraoperative hemodynamic management and postoperative analgesia for elderly patients with inguinal hernia repair,and the incidence of adverse events is low.