髂腹下和髂腹股沟神经阻滞在小儿腹股沟区手术中的麻醉效果  

Anesthetic effect of iliohypogastric or ilioinguinal nerve block in pediatric inguinal region surgery

作　　者：刘淑贤[1] 胡宏东 郑晓玲[1] 冯志咏 梁高炜 

机构地区：[1]广州市花都区妇幼保健院麻醉科,广州510800

出　　处：《中国当代医药》2016年第15期44-46,50,共4页China Modern Medicine

基　　金：广东省广州市花都区科技计划项目(15-HDWS-042)

摘　　要：目的探讨髂腹下和髂腹股沟神经阻滞（IINB）在小儿腹股沟区手术中的麻醉效果。方法选取我院2015年3-12月行小儿腹股沟区手术患者120例,随机将其分为两组,每组各60例,观察组（IINB）用药1%利多卡因复合0.15%罗哌卡因混合液0.3-0.5 ml/kg,对照组（骶管神经阻滞）用药1%利多卡因复合0.15%罗哌卡因混合液0.8 ml/kg。记录神经阻滞时（T1）、手术切皮时（T2）、疝囊（鞘突）结扎时（T3）及清醒时（T4）的平均动脉压（MAP）、心率（HR）,术中及术后的不良反应,丙泊酚总用量,苏醒时间,手术时间,采用身体语言反应测试方式（FLACC）对术后2、4、6 h进行疼痛评分。结果与T1比较：观察组MAP、HR变化差异无统计学意义（P〉0.05）,对照组T2、T4时MAP,T4时HR高于T1,差异有统计学意义（P〈0.05）;T3时MAP、T2时的HR明显高于T1,差异有统计学意义（P〈0.01）。与对照组比较：观察组在T3、T4时MAP,T2时的HR明显低于对照组（P〈0.01）,在T3、T4时的HR低于对照组（P〈0.05）;观察组不良反应明显少于对照组（P〈0.01）,苏醒时间明显短于对照组（P〈0.01）,丙泊酚总用量少于对照组（P〈0.05）,术后4 h FLACC疼痛评分低于对照组（P〈0.05）,术后6 h FLACC疼痛评分低于对照组（P〈0.01）。结论 IINB麻醉方式在小儿腹股沟区手术中的麻醉效果较好,具有临床推广价值,值得推广。Objective To report the anesthetic effect of iliohypogastric or ilioinguinal nerve block in pediatric inguinal region surgery. Methods A total of 120 pediatric patients from March to December in 2015 were randomly divided into two groups（n=60）：IINB groupand Caudal block group,IINB group received 1% lidocaine and 0.15% ropivacaine at0.3-0.5 ml/kg,Caudal block group received 1% lidocaine and 0.15% ropivacaine at 0.8 ml/kg.The vital signs of mean arterial pressure（MAP） and heart rate（HR） were recorded in four time points during surgery：the time of nerve block（T1）,the skin incision（T2）,ligating hernial sac（sheath dcs）（T3）,waking time（T4）,intraoperation and postoperation adverse events,the total dosages of propofol,the recover time from anesthesia,surgery time were also recorded,Face legs activity cry consolability（FLACC） score was used to assess the pain score postoperatively at 2,4,6 h postoperation respectively.Results In IINB group,the difference of MAP、HR were no statistical significance（P〈0.05）.In Caudal block group,MAP at T2,T4,and HR at T4 were higher than those at T1,the differences were statistical significance（P〈0.05）;MAP at T3,HR at T2 were significantly higher than those at T1,the differences were significantly statistical significance（P〈0.01）.MAP at T3,T4,and HR at T2 in IINB group were significantly lower than those in Caudal block group（P〈0.01）,HR at T3,T4 in IINB group were lower than those in Caudal block group（P〈0.05）,the adverse events in IINB group were significantly less,the recover time from anesthesia in IINB group were significantly shorter than those in Caudal block group（P 0.01）,the total dosages of propof＇ol in IINB group were less than those in Caudal block group（P〈0.05）,the FLACC pain scores at 4 h postoperation in IINB group were lower than those in Caudal block group（P〈0.05）,the FLACC pain scores at 6 h postoperation in IINB group were significantly lower than those in Caudal block group（P〈0.01

关 键 词：神经阻滞 髂腹下-髂腹股沟神经 骶管神经 小儿麻醉 

分 类 号：R726.1[医药卫生—儿科]