两种镇痛方式在小儿腹股沟疝修补术中的应用  

Ultrasound-guided transversus abdominis plane block versus local infiltration in pediatric laparoscopic inguinal hernia repair

作　　者：陈丽辉[1] 王涛 刘湘杰[1] 梁秀兰[1] 王远胜[1] Chen Lihui;Wang Tao;Liu Xiangjie;Liang Xiulan;Wang Yuansheng(Department of Anesthesiology,Jiangmen Central Hospital,Jiangmen 529000,China)

机构地区：[1]江门市中心医院,广东529000

出　　处：《国际医药卫生导报》2021年第9期1325-1328,共4页International Medicine and Health Guidance News

基　　金：江门市科技局项目(201801002001176)。

摘　　要：目的比较超声引导下腹横平面阻滞和切口局部浸润麻醉对腹腔镜疝囊高位结扎术患儿术后早期疼痛的影响。方法选择2019年1月至12月于江门市中心医院行择期腹腔镜下腹股沟疝疝囊高位结扎术患儿100例,ASAⅠ~Ⅱ级,年龄范围为4~8岁,根据镇痛方式不同分为两组,每组50例:切口局部浸润麻醉组[男48例,女2例,年龄(6.13±2.07)岁)]和腹横平面阻滞组[男49例,女1例,年龄(6.42±2.54)岁]。切口局部浸润麻醉组患儿行腹腔镜3个切口局部浸润并给予0.2%罗哌卡因0.2 ml/kg;腹横平面阻滞组患者行双侧后入路腹横平面阻滞,每侧注射0.2%罗哌卡因,0.5 ml/kg,阻滞完成后10 min开始手术。采用东大略儿童医院疼痛评分(Children’s Hospital of Eastern Ontario Pain Scale,CHEOPS)对患儿术后30 min、1 h、4 h、6 h和24 h进行疼痛评估。记录各时间点需要追加曲马多的例数、不良反应的发生情况和患儿家属的满意度。结果切口局部浸润麻醉组术后30 min、1 h、4 h、6 h和24 h CHOEPS评分分别为(5.21±0.43)分、(5.30±0.75)分、(5.01±0.59)分、(6.09±0.13)分、(7.32±0.76)分,腹横平面阻滞组分别为(4.90±0.18)分、(4.80±0.41)分、(5.09±0.31)分、(5.00±0.64)分、(5.28±1.03)分,两组患儿术后30 min、1 h和4 h CHOEPS评分差异均无统计学意义(均P>0.05),腹横平面阻滞组术后6 h和24 h CHEOPS评分均较切口局部浸润麻醉组明显降低(均P<0.05)。腹横平面阻滞组术后24 h需要追加曲马多比例(54.0%,27/50)明显低于切口局部浸润麻醉组(90.0%,45/50)(P<0.001)。腹横平面阻滞组患儿家属满意度(98.0%,49/50)显著高于切口局部浸润麻醉组(84.0%,42/50)(χ^(2)=5.983,P=0.014),两组患儿术后恶心呕吐发生率比较,差异无统计学意义(χ^(2)=0.344,P=0.558)。结论术前超声引导下腹横平面阻滞和切口局部浸润麻醉均能为儿童腹腔镜疝囊高位结扎术提供良好的早期术后镇痛,但腹横平面阻滞时间更长,患儿家�Objective To explore the effects of ultrasound-guided transversus abdominis plane block versus local infiltration in pediatric laparoscopic inguinal hernia repair on early postoperative analgesia.Methods From January to December,2019,100 ASAⅠ-Ⅱpediatric patients who underwent laparoscopic high ligation of the hernia sac in Jiangmen Central Hospital and who were 4-8 years old were divided into an local infiltration group and a transversus abdominis plane block group according to the analgesia methods,with 50 cases in each group.There were 48 males and 2 females in the local infiltration group;they were(6.13±2.07)years old.There were 49 males and 1 female in the transversus abdominis plane block group;they were(6.42±2.54)years old.After anesthesia induction and intubation,the local infiltration group took local infiltration through three laparoscopic incisions and 0.2 ml/kg 0.2%ropivacaine.The transversus abdominis plane block group took transversus abdominis plane block through posterior approach and 0.5 ml/kg ropivacaine on both sides,and started the operation 10 min after the block.The scores of Children's Hospital of Eastern Ontario Pain Scale(CHEOPS)were recorded 30 min,1 h,4 h,6 h,and 24 h after the operation.The number of patients needed additional tramadol,adverse reactions,and the family members'satisfaction were recorded.Results The CHEOPS scores 30 min,1 h,4 h,6 h,and 24 h after the operation were(5.21±0.43),(5.30±0.75),(5.01±0.59),(6.09±0.13),and(7.32±0.76)in the local infiltration group,and were(4.90±0.18),(4.80±0.41),(5.09±0.31),(5.00±0.64),and(5.28±1.03)in the transversus abdominis plane block group,with no statistical differences between these two groups 30 min,1 h,and 4 h after the operation(all P>0.05),and with statistical differences 6 and 24 h after the operation(both P<0.05).Within 24 h after the operation,54.0%(27/50)patients in the transversus abdominis plane block group and 90.0%(45/50)needed additional tramadol(P<0.001).The family members'satisfaction was higher in the trans

关 键 词：腹横平面阻滞 儿童 腹股沟疝 切口局部浸润麻醉 罗哌卡因 术后镇痛 

分 类 号：R726.1[医药卫生—儿科]