超声引导骶管阻滞对尿道下裂成形术炎性反应的影响  

作　　者：杨纲华[1] 林静丽[1] 林蔼婷 王韬[1] 王立勋[1] 

机构地区：[1]南方医科大学附属小榄医院麻醉科,528415

出　　处：《浙江临床医学》2016年第2期228-230,共3页Zhejiang Clinical Medical Journal

摘　　要：目的研究超声引导-F#L管阻滞复合全身麻醉对尿道下裂成形术围术期炎性反应的影响。方法选择1～6岁择期行尿道下裂成形术患）L60例，采用随机数字表法，将其分为单纯全身麻醉对照组（I组）和骶管阻滞复合全身麻醉组（／／组），每组各30例。记录两纽患者手术时间、喉罩拔除时间、麻醉苏醒时间、麻醉后恢复室（PACU）停留时间。分别在麻醉诱导前（T1）、手术开始后30min（T2）、术毕（T3）、术后2h（T4）、术后12h（T5）抽取患者静脉血，测定血清IL-6、IL-10及TNF-α浓度，同时观察MAP和HR的变化。结果与T1时比较，T3、T4、T5两组血清IL-6、IL-10及TNF-α浓度明显升高（P〈0．05）。与I组比较，T3、T4、T5时Ⅱ纽血清IL-6、TNF-α浓度升高幅度明显降低、IL-10浓度升高幅度明显增加（P〈0．05），与I组比较，Ⅱ组喉罩拔除时间、麻醉苏醒时间、PACU停留时间明显缩短（P〈0．05）。与T1时比较，T2、T3时I组MAP和HR明显升高（P0．05）、Ⅱ组MAP和HR差异均无统计学意义（P〉0．05）；与Ⅱ组比较，T2、T3时I组平均血压（MAP）和心率（HR）明显升高（P〈0．05）。结论与单纯喉罩插管全身麻醉比较，超声引导骶管阻滞复合全身麻醉在尿道下裂成形术患儿术中血流动力学平稳，能有效抑制炎性反应，有利于患者术后恢复。Objective To study the effect of percutaneous sacral canal block compound anesthesia guided by ultrasound on the perioperative inflammatory reaction after urethroplasty for hypospadias. Methods 60 cases of 1~6 years old children who had undertaken urethroplasty for hypospadias were choosen, and were divided by random number table method into two groups （ n=30 ） , which were pure general anesthesia group （ group I ） and sacral canal block compound anesthesia group （ group Ⅱ ） . Operation time, postoperative laryngeal mask time, anesthesia waking time, PACU time of the two groups were investigated. Respectively at the time points of before anesthesia induction （ T1 ） , 30 min after the start of operation （ T2 ） , end （ T3 ） , 2 h after surgery （ T4 ） and 12 h after surgery （ T5 ） , samples of venous blood were taken to determine serum IL - 6, IL - 10 and TNF - α concentration. At the same time the change of MAP and FIR were observed. Results At T3, T4 and T5, serum IL - 6, IL - 10 and TNF- tx concentration increased significantly （ P〈0.05 ） compared with those at T1 in both the two groups. Compared with group I, the rises of serum IL - 6 and TNF- α of T3, T4 and T5 significantly reduced, whereas, the rise of IL - 10 increased significantly （ P〈0.05 ） . Compared with group I, in group 1/ the postoperative laryngeal mask time, anesthesia waking time and PACU time were significantly shorter （ P〈0.05 ） . When compared with T1 and T2, MAP and HR at T3 were significantly elevated in group Ⅰ （ P〈0.05 ） . However, in group Ⅱ, there was no statistical significance （ P〉0.05 ） . Compared with group Ⅱ, MAP and HR significantly elevated in group I at T2 and T3 （ P〈0.05 ） . Conclusions Compared with pure laryngeal mask intubation general anesthesia, sacral canal block compound general anesthesia guided by ultrasound for children with hypospadias in urethroplasty can obtain more intraoperative hemodynamic stability. Furthermore, it can effectively inhi

关 键 词：超声检查 喉罩 骶管阻滞 全身麻醉 炎性反应 

分 类 号：R696[医药卫生—泌尿科学]