腹横肌神经阻滞联合喉罩全麻在老年腹股沟无张力疝修补术中的应用  

Application of Transversus Abdominis Nerve Block Combined with Laryngeal Mask General Anesthesia in Tension-Free-Repair of Elderly Inguinal Hernia

作　　者：扈红亮 HU Hong-liang(Department of Anesthesiology,Yiyang County People’s Hospital,Luoyang 471600,Henan Province,China)

机构地区：[1]宜阳县人民医院麻醉科,河南洛阳471600

出　　处：《罕少疾病杂志》2022年第2期78-81,共4页Journal of Rare and Uncommon Diseases

摘　　要：目的观察腹横肌神经阻滞联合喉罩全麻在老年腹股沟无张力疝修补术中的应用效果。方法选择2018年1月至2018年12月本院收治的200例老年腹股沟疝行无张力疝修补术患者,按照随机数字表法分为研究组和对照组各100例,研究组采取腹横肌神经阻滞联合喉罩全麻,对照组仅进行喉罩全麻,比较两组围术期不同时间点[麻醉诱导前(T_(0))、喉罩插入后(T_(1))、手术开始时(T_(2))、手术结束时(T_(3))、拔喉罩时(T_(4))]平均动脉压、心率,记录麻醉时间、手术时间、术中丙泊酚、瑞芬太尼用量,比较术后不同时间点(术后2h、6h、12h、24h、48h)疼痛评分[视觉模拟评分(VAS)],记录术后苏醒时间、拔喉罩时间、活动恢复时间、48h芬太尼累计用量,并比较两组术后不良反应。结果研究组T_(2)、T_(3)、T_(4)时心率均显著低于对照组(P<0.05),术中丙泊酚用量、瑞芬太尼用量均显著低于对照组(P<0.05)。术后2h、术后6h、术后12h、术后24h、术后48h VAS评分均显著低于对照组(P<0.05),术后苏醒时间、拔喉罩时间、活动恢复时间、48h芬太尼累计用量均显著低于对照组(P<0.05)。术后恶心呕吐发生率为9.00%、尿潴留发生率为4.00%不良反应总发生率为13.00%均显著低于对照组(21.00%、12.00%、38.00%,P<0.05)。结论与单纯喉罩全麻比较,腹横肌神经阻滞联合喉罩全麻用于老年腹股沟无张力疝修补术中麻醉效果更好,能减少术中麻醉药用量,促进患者恢复,同时降低术后止疼药用量,减少相关不良反应。Objective To observe the application effect of transversus abdominis nerve block combined with laryngeal mask general anesthesia in the treatment of tension-free-repair of elderly inguinal hernia.Methods A total of 200 elderly patients with inguinal hernia who underwent tension-free hernia repair in the hospital between January 2018 and December 2018 were enrolled in the study.According to the random number table method,the patients were divided into study group and control group,with 100 cases in each group.Study group was given transversus abdominis nerve block combined with laryngeal mask general anesthesia,and control group was given laryngeal mask general anesthesia alone.The mean arterial pressure and heart rate of the the two groups were compared at different time points during perioperative period[before anesthesia induction(T_(0)),after laryngeal mask insertion(T_(1)),at the beginning of surgery(T_(2)),at the end of surgery(T_(3)),at laryngeal mask extraction(T_(4))].The anesthesia time,surgical time and intraoperative propofol and remifentanil dosages were recorded,and the pain score[Visual Analogue Scale(VAS)]was compared at different time points after surgery(at 2h,6h,12h,24h and 48h after surgery).The postoperative recovery time,time of laryngeal mask extraction,activity recovery time and 48h fentanyl cumulative dose were recorded,and the postoperative adverse reactions were compared between the two groups.Results The heart rate at T_(2),T_(3) and T_(4) in study group was significantly lower than that in control group(P<0.05),and the dosages of intraoperative propofol and remifentanil were significantly lower than those in control group(P<0.05),and the VAS scores at 2h,6h,12h,24h and 48h after surgery were significantly lower than those in control group,and the postoperative recovery time,time of laryngeal mask extraction,activity recovery time and 48h fentanyl cumulative dose were all significantly lower than those in control group(P<0.05),and the incidence rate of postoperative nausea and vomiting,

关 键 词：老年腹股沟疝 无张力疝修补术 腹横肌神经阻滞 喉罩全麻 

分 类 号：R614[医药卫生—麻醉学] R656.2[医药卫生—外科学]