不同麻醉方法在腹股沟疝修补术的效果比较  

Comparison of anesthesia effects of different anesthesia methods in inguinal hernia repair

作　　者：张丹妮[1] 段霞光[1] 郝春光[1] 支小军[1] 黄再青[1] Zhang Danni;Duan Xiaguang;Hao Chunguang;Zhi Xiaojun;Huang Zaiqing(Department of Anesthesiology,Inner Mongolia Baogang Hospital,Baotou 014010,Inner Mongolia,China)

机构地区：[1]内蒙古包钢医院麻醉科,包头014010

出　　处：《中华疝和腹壁外科杂志（电子版）》2021年第2期181-185,共5页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

基　　金：内蒙古自治区自然科学基金(2018MS08041)。

摘　　要：目的探讨超声引导下的腰方肌阻滞、腹横肌平面阻滞在腹股沟疝修补术的麻醉效果差异。方法选择2018年8月至2020年8月在内蒙古包钢医院接受腹股沟疝修补手术治疗的患者56例。28例超声引导下腹横肌平面阻滞的患者作为对照组,28例超声引导下腰方肌阻滞的患者作为观察组。对比2组的血流动力学指标[麻醉前、手术开始、手术15min、手术30min的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO_(2))]、右美托咪定使用量、利多卡因使用例数、术后4、8、12、24、48 h患者的视觉模拟评分法(VAS)、血清炎性因子指标[C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、术后并发症情况。结果2组患者在麻醉前、手术开始、手术15 min、手术30 min的MAP、HR、SpO_(2)水平差异无统计学意义(P>0.05)。2组患者的右美托咪定使用量与利多卡因使用例数差异无统计学意义(P>0.05)。观察组在术后24 h、48h的VAS评分低于对照组(P<0.05)。2组在术后4、8、12 h的VAS评分差异无统计学意义(P>0.05)。术后1 d,2组的CRP、IL-6、TNF-α均增高(P<0.05),但观察组的CRP、IL-6、TNF-α均低于对照组(P<0.05)。2组术后并发症发生率差异无统计学意义(P>0.05)。结论对于接受腹股沟疝修补手术的患者,采用超声引导下的腹横肌平面阻滞和腰方肌阻滞,均可以获得较为理想的麻醉效果,患者的心率和血压等指标在手术过程中均可保持稳定,均具有良好的安全性。腰方肌阻滞在术后可以持续更长时间的镇痛作用,同时更有利于稳定血清炎性因子水平。Objective To investigate the difference of anesthesia effect between quadratus lumbarum block and transversus abdominis plane block guided by ultrasound in inguinal hernia repair.Methods From August 2018 to August 2020,56 patients with inguinal hernia repair in Inner Mongolia Baogang Hospital were selected.28 patients with ultrasound-guided transversus abdominis plane block were served as control group,and 28 patients with ultrasound-guided quadratus lumbarum block were used as observation group.The hemodynamic indexes(MAP,HR,SpO_(2) before anesthesia,at the beginning of surgery,at 15,30 minutes during the surgery),dexmedetomidine dosage,cases number of lidocaine used,pain score(VAS)at 4,8,12,24,48 hours,serum inflammatory factor index[C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)],and postoperative complications were compared between the two groups.Results There were no significant differences in MAP,HR and SpO_(2) between the two groups before anesthesia,at the beginning of operation,15 and 30 minutes during operation(P>0.05).There were no significant differences in the dosage of dexmedetomidine used and the number of cases of lidocaine used between the two groups(P>0.05).The VAS score of the observation group at 24 and 48 hours after operation was lower than those of the control group(P<0.05).There were no significant differences in VAS score between the two groups at 4,8 and 12 hours(P>0.05).The levels of CRP,IL-6 and TNF-αin both groups were increased on the 1 st day after operation(P<0.05).However,the levels of CRP,IL-6 and TNF-αin the observation groupat 1 st day after operation were lower than those in the control group(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion For patients undergoing inguinal hernia repair surgery,ultrasound-guided transversus abdominis plane block and quadratus lumbarum block can obtain ideal anesthesia effect.The heart rate and blood pressure data of patients can

关 键 词：疝 腹股沟 疝修补术 腰方肌阻滞 腹横肌平面阻滞 麻醉 神经阻滞 

分 类 号：R614[医药卫生—麻醉学]