超声引导单次骶管阻滞在新生儿肛门闭锁纠治术中的应用价值  

Application value of ultrasound-guided single caudal block in neonates undergoing correction of anal atresia

作　　者：孙盈盈 蔡玉柱 刘兴慧 刘磊 叶宏武 SUN Yingying;CAI Yuzhu;LIU Xinghui;LIU Lei;YE Hongwu(Department of Anesthesiology,Anhui Provincial Children’s Hospital,Hefei 230051,China)

机构地区：[1]安徽省儿童医院麻醉科,合肥市230051

出　　处：《临床超声医学杂志》2021年第11期867-870,共4页Journal of Clinical Ultrasound in Medicine

基　　金：安徽省自然科学基金面上项目(1808085MH230);安徽省儿童医院三新技术项目(2018237)。

摘　　要：目的探讨超声引导单次骶管阻滞在新生儿肛门闭锁纠治术中的应用价值。方法选取我院行肛门闭锁纠治术的新生男婴50例,按随机数字表法分为传统体表标志定位单次骶管阻滞组(C组)与超声引导单次骶管阻滞组(U组),每组各25例。两组患儿均在七氟烷浅度全身麻醉下行单次骶管阻滞。比较两组患儿阻滞成功率、阻滞操作时间、穿刺针调整次数、穿刺失败率、阻滞并发症,麻醉诱导后即刻(T0)、骶管阻滞后5 min(T1)、手术开始即刻(T2)、手术结束即刻(T3)、苏醒后0.5 h(T4)的平均动脉压(MAP)和心率(HR),以及T4及苏醒后1 h(T5)、2 h(T6)、4 h(T7)、6 h(T8)的行为学量表(CRIES)评分。结果U组患儿阻滞成功率为100%,高于C组(84%);穿刺针调整次数为(1.48±0.51)次,少于C组(2.12±0.72)次;阻滞操作时间为(3.23±0.84)min,长于C组(1.84±0.69)min;两组比较差异均有统计学意义(均P<0.05)。两组间T0~T4各时间点MAP、HR比较差异均无统计学意义;组内T1时MAP降低,HR增高,与其他各时间点比较差异均有统计学意义(均P<0.001)。U组患儿术后T4、T5时CRIES评分均低于C组,组间及时间、组间交互比较差异均有统计学意义(P=0.025、0.031);两组T4、T5时CRIES评分均低于其他时间点,差异均有统计学意义(均P<0.001)。结论在新生儿肛门闭锁纠治术中使用超声引导单次骶管阻滞可提高阻滞的成功率,减少穿刺调整次数,改善术后疼痛评分。Objective To explore the application value of ultrasound-guided single caudal block in neonates undergoing correction of anal atresia.Methods A total of 50 male newborns who underwent anal atresia in our hospital were selected and divided into two groups according to random number table:traditional body surface marker positioning caudal block group(group C)and ultrasonics guided caudal block group(group U),with 25 cases in each group.Single caudal block was performed after general anesthesia induced by sevoflurane in both groups.The success rate of block operation,the time of block operation,the adjustment times of puncture and the rate of failure,the complications of block were recorded and compared between the two groups.The mean arterial pressure(MAP)and heart rate(HR)immediately after anesthesia induction(T0),5 min after caudal block(T1),initiation of operation(T2),immediately after operation(T3),and 0.5 h after awakening(T4)were compared.The scores of the CRIES scale were compared at T4 and 1 h(T5),2 h(T6),4 h(T7),6 h(T8)after awakening respectively.Results Compared with group C,the success rate of block was higher in group U(100%vs.84%),the adjustment times of puncture was lower in group U(1.48±0.51 vs.2.12±0.72),the time of block operation was longer in group U[(3.23±0.84)min vs.(1.84±0.69)min],and there were statistically significant differences between the two groups(all P<0.05).There were no statistically significant differences of MAP and HR at T0~T4 time points between the two groups,but MAP decreased and HR increased at T1,and the differences were statistically significant compared with other time points(all P<0.001).The CRIES score of the group U at T4 and T5 were lower than those of the group C,there were statistically significant differences in terms of time and interaction between the groups(P=0.025,0.031).The CRIES scores at T4 and T5 were lower than those at other time points,and the differences were statistically significant(all P<0.001).Conclusion Application of ultrasound-guided single c

关 键 词：超声引导 神经阻滞 骶管阻滞 肛门闭锁 新生儿 

分 类 号：R445.1[医药卫生—影像医学与核医学] R614.4[医药卫生—诊断学]