超声引导下TAPB联合RSB在新生儿腹腔镜幽门环肌切开术中的麻醉应用  

作　　者：高瑞 汪洁 吴星 冯慧悦 马益平 

机构地区：[1]杭州市儿童医院,310014

出　　处：《浙江临床医学》2019年第10期1387-1389,共3页Zhejiang Clinical Medical Journal

摘　　要：目的观察超声引导下的双侧腹横肌平面阻滞(TAPB)联合腹直肌鞘阻滞(RSB)对新生儿先天性肥厚性幽门狭窄(CHPS)行腹腔镜下幽门环肌切开术中的麻醉效果.方法选择行腹腔镜幽门环肌切开术新生儿40例,ASA分级Ⅰ-Ⅱ级,出生15~28d,采用随机数字表分为超声引导下TAPB联合RSB复合全身麻醉组(A组)和全身麻醉组(B组),每组各20例.气管插管后A组行超声引导下的双侧TAPB和双侧RSB.TAPB给予0.1%罗哌卡因0.4ml/kg,RSB给予0.1%罗哌卡因0.1ml/kg.两组均采用静吸复合麻醉,吸入七氟烷、静脉泵注瑞芬太尼维持麻醉,使BIS值在50~60.记录术中瑞芬太尼的用量;手术结束时七氟烷的吸入浓度及呼出浓度;记录手术时间、手术结束至拔除气管导管时间(拔管时间)、PACU滞留时间;记录需要补救镇痛、拔管时并发症如喉痉挛、PACU期间呼吸抑制(SpO2<90%,RR<15次/min)及恶心呕吐等不良反应发生情况.结果与B组比较,A组术中瑞芬太尼用量明显降低(P<0.05),A组拔管时间缩短(P<0.05);手术结束时七氟烷的吸入浓度、呼出浓度两组比较差异无统计学意义(P>0.05),PACU滞留时间两组比较差异无统计学意义(P>0.05);在拔管期B组4例(20%)患儿发生喉痉挛,在PACU期间B组20例(100%)患儿需要补救镇痛,3例(15%)患儿发生恶心呕吐;A组无一例不良反应的发生.结论超声引导TAPB联合RSB辅助全身麻醉减少新生儿腹腔镜幽门环肌切开术中瑞芬太尼的用量,缩短拔管时间,减少术后疼痛,麻醉效果优于单纯全身麻醉,增加新生儿上腹部手术麻醉的安全性.Objective To evaluate the efficacy of bilateral ultrasound(US)-guided transversus abdominis plane block(TAPB)and rectus sheath block(RSB)for laparoscopic pyloromyotomy in neonates with congenital hypertrophic pyloric stenosis(CHPS).Methods Forty neonates(15~28days,ASA 1—2)for laparoscopic pyloromyotomy were randomized to TAPB and RSB combined with general anesthesia group(Group A;n=20)or general anesthesia group(Group B;n=20)by using a random number table.The TAPB and RSB were performed after tracheal intubation,the local anesthetic drugs was injected bilaterally on TAPB with 0.1% ropivacaine 0.4ml/kg and RSB with 0.1%ropivacaine O.lml/kg.All the participants were anesthetized by inhaling sevoflurane and intravenous infusion of remifentanil,and BIS was kept between 50-60.The dosage of remifentanil used in operation was recorded;the inhaled and exhaled concentration of sevoflurane at the end of the operation were recorded;the operation time,the extubation time and the length of stay in the PACU were recorded;the supplemental analgesics were recorded;complications such as laryngospasm during extubation,the occurrence of adverse reactions such as respiratory depression during PACU(SpO2<90%,RR<15 times per minute),nausea and vomiting were also recorded.Results Compared with group B,the dosage of remifentanil was significantly lower in group A(P<0.05);the extubation time was shortened in group A(P<0.05).There was no significant difference between the two groups in the inhaled and exhaled concentration of sevoflurane at the end of the operation(P>0.05).There was no significant difference in the PACU stay(P>0.05).Laryngospasm occurred in 4(20%)neonates in group B during extubation.20 neonates(100%)in group B needed the supplemental analgesics during PACU.Nausea and vomiting occurred in 3 neonates(15%)in group B.No adverse events were recorded in group A.Conclusion Ultrasound-guided TAPB and RSB assisted general anesthesia can reduce the dosage of remifentanil in neonates undergoing laparoscopic pyloromyotomy intraoper

关 键 词：腹横肌平面阻滞 腹直肌鞘阻滞 腹腔镜 先天性肥厚性幽门狭窄 新生儿 

分 类 号：R61[医药卫生—外科学]