两种麻醉方法在老年患者腹股沟疝修补术中效果的比较  

Comparison of the anesthetic effects of two anesthesia methods for inguinal hernia repair in elderly patients

作　　者：朱尤壮 柴军[1] Zhu Youzhuang;Chai Jun(Department of Anesthesiology,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院麻醉科,沈阳110004

出　　处：《中国医师进修杂志》2020年第9期779-783,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨区域麻醉镇静下超声引导双腹横肌平面阻滞(TAPB)和局部浸润麻醉在老年患者腹股沟疝修补术中的效果比较。方法选取2019年3—9月中国医科大学附属盛京医院择期行单侧腹股沟疝修补术老年患者60例。将患者按随机数字表法分为两组,采用区域麻醉镇静下超声引导双TAPB(侧路TAPB联合髂腹下/髂腹股沟TAPB)30例(观察组),采用局部浸润麻醉30例(对照组)。观察组采用的局部麻醉药为0.375%罗哌卡因,对照组采用的局部麻醉药为0.5%利多卡因。记录两组麻醉前(T1)、手术切皮时(T2)、打开腹外斜肌腱膜时(T3)、疝囊剥离时(T4)、放置补片时(T5)、缝合腹外斜肌筋膜时(T6)、皮肤切口闭合时(T7)的平均动脉压(MAP)和心率,记录T2~T5及术后2、4、6、12和24 h疼痛视觉模拟评分(VAS);记录改行全身麻醉、术后需要行补救镇痛以及恶心呕吐、局部麻醉药中毒、穿刺针误入腹腔、心脑血管意外等发生情况。结果两组患者均成功实施了麻醉,并顺利完成手术。观察组和对照组手术时间比较差异无统计学意义[(37.20±6.46)min比(38.03±4.87)min,P>0.05]。两组T1 MAP和心率比较差异无统计学意义(P>0.05);观察组T2~T7 MAP和心率明低于对照组,差异有统计学意义(P<0.05)。观察组T2~T5及术后4~12 h VAS明显低于对照组[(1.87±0.94)分比(4.73±1.11)分、(1.33±0.24)分比(6.77±1.04)分、(2.10±0.99)分比(7.30±0.65)分、(2.39±0.63)分比(5.07±0.87)分、(2.60±0.17)分比(4.47±0.65)分、(3.13±0.51)分比(6.32±0.44)分和(4.28±0.76)分比(6.60±0.57)分],差异有统计学意义(P<0.05);两组术后2和24 h VAS比较差异无统计学意义(P>0.05)。观察组改行全身麻醉、术后需要行补救镇痛率明显低于对照组[0比33.3%(10/30)和6.7%(2/30)比83.3%(25/30)],差异有统计学意义(P<0.05);两组恶心和呕吐发生率比较差异无统计学意义(P>0.05)。两组均未发生局部麻醉药中毒、穿刺针误入腹腔、心Objective To compare the effects of ultrasound-guided double transverse abdominis plane block(TAPB)under regional anesthesia sedation and local infiltration anesthesia in inguinal hernia repair in elderly patients.Methods A total of 60 elderly patients who underwent unilateral inguinal hernia repair in Shengjing Hospital of China Medical University from March to September 2019 were selected.The patients were divided into 2 groups by random digits table method.Thirty cases were treated with ultrasound-guided double TAPB(lateral TAPB combined with iliohypogastric/ilioinguinal TAPB)under regional anesthesia sedation(observation group)and 30 cases with local infiltration anesthesia(control group).The local anesthetic was 0.375%ropivacaine in observation group and 0.5%lidocaine in control group.The mean arterial pressure(MAP)and heart rate were recorded at these time points:preanesthesia(T1),beginning of skin incision(T2),operation of external oblique aponeurosis(T3),anatomy of hernial sac(T4),operation of placing patch(T5),suturing of external oblique aponeurosis(T6)and closing skin incision(T7).The visual analogue scale(VAS)at T2 to T5 and 2,4,6,12 and 24 h after surgery were recorded.The occurrence of general anesthesia,postoperative remedial analgesia,nausea and vomiting,local anesthetic intoxication,accidental intraperitoneal injection and cardiovascular and cerebrovascular accident were recorded.Results Both groups of patients were successfully anesthetized and completed the operation.There was no statistically significant difference in operation time between observation group and control group:(37.20±6.46)min vs.(38.03±4.87)min,P>0.05.There were no statistical difference in MAP and heart rate at T1 between 2 groups(P>0.05).The MAP and heart rate at T2 to T7 in observation group were significantly lower than those in control group,and there were statistical differences(P<0.05).The VAS at T2 to T5 and 4 to 12 h after operation in observation group was significantly lower than that in control group:(1.87±0.94)s

关 键 词：麻醉 传导 麻醉 局部 老年人 疝 腹股沟 

分 类 号：R614[医药卫生—麻醉学]