超声引导下IINB复合喉罩通气在小儿腹股沟区手术中的应用效果

摘要

目的 探讨超声引导下髂腹股沟-髂腹下神经阻滞(IINB)复合喉罩全身麻醉在小儿腹股沟区手术中的应用效果.方法 选取择期行腹股沟区手术患儿60例,随机分为喉罩全身麻醉组(Ⅰ组)、超声引导下IINB复合喉罩全身麻醉组(Ⅱ组)与骶管神经阻滞复合喉罩全身麻醉组(Ⅲ组),每组各20例.记录患儿入手术室时(T0)、切皮时(T1)、牵拉疝囊时(T2)、苏醒时(T3)各点的心率、呼吸频率、平均动脉压、七氟烷呼气末浓度;记录术中因镇痛不足而发生体动及因术中提高七氟烷浓度而引起呼吸抑制的例数,术后烦躁的例数;记录手术时间和苏醒时间及对患儿苏醒时、术后2h、4h进行疼痛评分,当评分>4分时,静脉滴注曲马多2mg/kg,并记录每组患儿使用曲马多的例数.结果 Ⅱ组和Ⅲ组在T1,T2,T3时HR,RR,MAP均小于Ⅰ组(P<0.05),Ⅱ组七氟烷呼气末浓度T1,T2时低于Ⅰ组和Ⅲ组(P<0.05),Ⅰ组T1,T2,T3时HR,RR,MAP均大于T0(P<0.05),Ⅱ组和Ⅲ组各点无明显变化.I组和Ⅲ组体动、呼吸抑制、术后烦躁例数多于Ⅱ组(P<0.05),I组和Ⅲ组苏醒时间长于Ⅱ组(P<0.05).I组患儿苏醒时、术后2 h、4h疼痛评分高于Ⅱ组和Ⅲ组(P<0.05).结论 超声引导下IINB复合全身麻醉局麻药用量较少,麻醉并发症少,可安全有效的应用于临床.%Objective To evaluate the clinic efficacy of ultrasound guidance for iliohypogastric nerve / ilioinguinal nerve block(IINB) combined with laryngeal mask airway anesthesia in pediatric inguinal region surgery.Methods Sixty children were randomly divided into three groups:laryngeal mask anesthesia group(group I),IINB combined with laryngeal mask anesthesia group(group Ⅱ)and caudal block combined with laryngeal mask anesthesia group(group Ⅲ). The vital signs of heart rate(HR),respiratory rate(RR),mean arterial pressure(MAP) and exhaled sevoflurane concentration were recorded in four points during surgery:the basal(T0),the skin incision(T1),hernia sac traction (T2),waking time(T3).Additional intraoperative analgesic requirements,postoperative agitation,surgery time and recover time from anesthesia were recorded. Face legs activity cry consolability(FLACC)scores used to assess the pain postoperatively at recovery time,2 and 4h postoperation respectively.Results HR,RR,and MAP at T1,T2,T3 in group Ⅱ and Ⅲ were significantly lower than those in group I(P<0.05),the level of exhaled sevoflurane concentration at T1,T2 in group Ⅱ was significantly lower than that in group I and Ⅲ(P<0.05).In group I,HR,RR, and MAP at T1,T2,T3 were significantly higher than those at T0(P<0.05),In group Ⅱ and Ⅲ,the difference of HR,RR,MAP and exhaled sevoflurane concentration were no statistical significance at any time points. In group I and Ⅲ,the number of the children with intraoperative body movement,respiratory depression or postoperative agitation was more than those in group Ⅱ(P<0.05). The recovery time was longer in group I and Ⅲ than that in group Ⅱ(P<0.05). The pain scores at recovery time,2h and4h postoperation in group Ⅱ and Ⅲ were significantly lower than those in group I(P<0.05).Conclusion In the three methods,the method of ultrasonic guidance for iliohypogastric nerve / ilioinguinal nerve block combined with laryngeal mask airway anesthesia is safety and clinical effective.It also can reduce the occurrences of complications,lower the quantity of local anesthetic.