腹横肌平面阻滞复合全麻在小儿腹股沟区手术中的效果

摘要

目的：评估超声引导腹横肌平面阻滞在小儿腹股沟区手术中麻醉和镇痛效果。方法择期行腹股沟区手术患儿50例，ASAⅠ~Ⅱ级，年龄3~8岁，随机分为单纯全身麻醉组(A组)和超声引导下腹横肌平面阻滞复合全麻组(B组)。记录术前(T1)、手术切皮时(T2)、苏醒时(T3)各时点患儿的HR、MAP变化，记录氯胺酮、丙泊酚总用量和术后苏醒时间，以及术后患儿躁动及恶心、呕吐情况；采用疼痛行为评估表(FLACC)对患儿苏醒术后2 h、术后5 h和术后8 h行疼痛行为评分。结果①两组患儿的年龄、性别、体重差异均无统计学意义(P>0.05)；②与T1相比较，A组HR、MAP在T2、T3明显升高，差异有显著统计学意义(P<0.01)，与A组比较，B组HR、MAP在T2、T3变化较小，差异有显著统计学意义(P<0.01)；③与A组比较，B组苏醒时间较短、氯胺酮用量、丙泊酚用量较少，差异有显著统计学意义(P<0.01)，B组术后躁动率低(P<0.05)，两组患儿的术中术后恶心呕吐比较差异无统计学意义(P>0.05)；④B组在术后2 h、5 h、8 h FLACC评分低于A组，差异有显著统计学意义(P<0.01)。结论超声引导下腹横肌平面阻滞在小儿腹股沟区手术能提供良好术中麻醉效果和术后镇痛，且能减少全麻药用量，不良反应少，患儿恢复快。%Objective To evaluate the anesthetic and analgesic effect of ultrasound-guided transversus abo-dominis plane (TAP) block in pediatric inguinal surgery. Methods Fifty ASAⅠorⅡpatients, aged 3~8 years old, un-dergoing inguinal surgery, were randomly divided into the general anesthesia group (group A) and ultrasound-guided trans-versus abodominis plane block combined with general anesthesia group (group B). Mean arterial pressure (MAP), heart rate (HR) of the children were recorded before the surgery (T1), during the skin dicision (T2), and after palinesthesia (T3) re-spectively. Besides, the amount of propofol and ketamine, the total operative time, the postoperative awake time, the rest-lessness and the nausea and vomiting were recorded. Flace legs activity cry consolability (FLACC) score was used to as-sess the pain score at postoperative 2 h, 5 h, 8 h, respectively. Results ①There was no significant difference in age, gen-der, and weight of the patients between the two groups (P>0.05).②HR and MAP at T2 and T3 were significantly higher than those at T1 in group A (P<0.01);Compared with group A, HR and MAP in group B were significantly lower than those at T2, T3 (P<0.01).③The total dosages of katamine and propofol and recovery time in group B were significantly different from those in group B (P<0.01);the postoperative restlessness cases in group B were far fewer than those in group A (P<0.05). The nausea and vomiting in two groups showed no significant difference (P>0.05).④The FLACC pain scores at 2 h, 5 h, 8 h after surgery in group B were significantly lower than those in group A (P<0.01). Conclusion Ultrasound-guid-ed TAP block can provide good anesthesia and postoperative analgesic effect. It can reduce adverse effects and need small-er dose of intravenous anesthasia drug, with quicker recovery.