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目的探讨超声引导下腹横肌平面阻滞(TAP)在小儿腹腔镜腹股沟疝手术中的临床应用和效果。方法选取广州市妇女儿童医疗中心儿科2015年1月至2016年8月收治的60例腹股沟疝患儿作为研究对象。全部患儿随机分为TAP组和NS组,每组各30例。常规全麻诱导后,在超声引导下,TAP组患儿使用0.25%盐酸罗哌卡因行双侧TAP阻滞,NS组患儿在相同部位注射等量氯化钠溶液。术中以盐酸瑞芬太尼及七氟醚进行维持麻醉。观察2组患儿术前一般状况、术中生命体征、手术时间、术后苏醒时间、术后镇痛评分以及镇痛药物使用情况。结果 2组患儿术前在性别、年龄、身高和体重方面差异无统计学意义(P>0.05)。手术时间和术后苏醒时间差异均无统计学意义(P>0.05)。术中2组患儿切皮前心率(HR)、收缩压(SBP)、舒张压(DBP)及血氧饱和度(SpO_2)比较差异无统计学意义,而切皮2 min时TAP组患儿HR、SBP及DBP显著低于NS组(P<0.05),SpO_2差异无统计学意义(P>0.05)。TAP组患儿在苏醒时、术后30 min、术后6 h和12 h的静息和咳嗽时VAS评分显著低于NS组(P<0.01,P<0.05),而术后24 h,静息和咳嗽时VAS评分差异无统计学意义(P>0.05)。TAP组患儿在苏醒时、术后30 min、术后6、12 h的FLACC评分显著低于NS组(P<0.05),术后24 h的2组FLACC评分差异无统计学意义(P>0.05)。NS组术后静脉使用曲马多患儿8例(26.7%)显著高于TAP组2例(6.7%)(P<0.01)。结论超声引导下TAP阻滞能有效改善小儿腹股沟疝手术治疗时的生命体征,减轻患儿术后疼痛,减少镇痛药物的用量并提高家属的满意度。
Objective To investigate the clinical application and effect of ultrasound-guided transverse abdominal plane block (TAP) in pediatric laparoscopic inguinal hernia surgery. Methods Sixty children with inguinal hernia admitted from January 2015 to August 2016 in the Children’s Medical Center of Guangzhou were enrolled. All children were randomly divided into TAP group and NS group, 30 cases in each group. After general anesthesia induction, bilateral TAP block was induced by 0.25% ropivacaine hydrochloride in TAP group under the guidance of ultrasound. In NS group, the same amount of sodium chloride solution was injected in the same place. Intraoperative anesthesia with remifentanil hydrochloride and sevoflurane. Preoperative general condition, intraoperative life and signs, operation time, postoperative recovery time, postoperative analgesia score and analgesic drug use were observed in two groups. Results There was no significant difference in gender, age, height and weight between the two groups before operation (P> 0.05). There was no significant difference in operative time and postoperative recovery time (P> 0.05). There were no significant differences in heart rate (HR), SBP, DBP and SpO_2 before operation in 2 groups HR, SBP and DBP were significantly lower than those in NS group (P <0.05), while there was no significant difference in SpO_2 (P> 0.05). The VAS scores of resting and coughing patients in TAP group were significantly lower than those in NS group (P <0.01, P <0.05) at 30 min after operation, at 6 h and 12 h after operation, and at 24 h after operation There was no significant difference in VAS scores between interest and cough (P> 0.05). FLACC score of the TAP group was significantly lower than that of the NS group at 30 min after operation and at 6 and 12 h after operation (P <0.05). There was no significant difference in FLACC score between the two groups at 24 h after operation (P> 0.05). Eight patients (26.7%) with intravenous tramadol in the NS group were significantly higher than those in the TAP group (6.7%) (P <0.01). Conclusion Ultrasound-guided TAP block can effectively improve the vital signs during operation of children with inguinal hernia, relieve postoperative pain, reduce the dosage of analgesic drugs and increase the satisfaction of family members.