超声引导下连续IINB在老年腹股沟疝修补术中的应用效果及对患者术后镇痛和恢复的影响  

Application of Ultrasound Guided Continuous Iliohypogastric/Ilioinguinal Nerve Block in Elderly Inguinal Hernia Repair and Its Effect on Postoperative Analgesia and Recovery of Patients

作　　者：李争卫 何爱萍[1] 赵玲[1] 韩彬[1] 党旭云[1] 陈刚[1] 李静[1] 王武涛[1] LI Zhengwei;HE Aiping;ZHAO Ling;HAN Bin;DANG Xuyun;CHEN Gang;LI Jing;WANG Wutao(Department of Anesthesiology,the First Affiliated Hospital of Xi'an Medical University,Xi'an 710077,China)

机构地区：[1]西安医学院第一附属医院麻醉科,西安710077

出　　处：《医学综述》2022年第8期1660-1664,共5页Medical Recapitulate

摘　　要：目的探讨超声引导下连续髂腹下和髂腹股沟神经阻滞(IINB)在老年腹股沟疝修补术中的应用效果及对患者术后镇痛和恢复的影响。方法选取2020年1月至2021年7月于西安医学院第一附属医院拟接受腹股沟疝修补术治疗的100例老年腹股沟疝患者为研究对象,依据随机数字表法分为观察组和对照组,各50例。对照组实施硬膜外麻醉,观察组实施超声引导下连续IINB。检测并对比两组入室时(T_(0))、首次麻醉完成后5 min(T_(1))、切皮时(T_(2))及手术结束时(T_(3))的心率、平均动脉压;采用视觉模拟评分法(VAS)评估两组术后即刻、术后6 h、12 h及24 h的镇痛情况;记录两组手术、术后恢复活动和住院时间以及不良反应发生情况。结果心率和平均动脉压组间、时点间的主效应差异有统计学意义(P<0.01),且存在交互作用(P<0.01),两组T_(1)~T_(2)时的心率和平均动脉压均较T_(0)时降低,但在T_(3)时回升,且观察组T_(1)~T_(3)时的心率和平均动脉压均高于对照组(P<0.05)。VAS评分组间、时点间的主效应差异有统计学意义(P<0.01),且存在交互作用(P<0.01),术后6 h和12 h的VSA评分均较术后即刻升高,但在术后24 h回降,且观察组术后6 h、12 h的VAS评分均低于对照组(P<0.05)。两组手术时间比较差异无统计学意义(P>0.05),观察组术后恢复活动时间和住院时间均短于对照组[2.0(1.0,2.0)d比3.0(3.0,3.0)d;3.0(3.0,4.0)d比6.0(5.0,7.2)d](均P<0.01)。观察组总不良反应发生率低于对照组[4.0%(2/50)比32.0%(16/50)](χ^(2)=13.279,P<0.001)。结论超声引导下连续IINB在老年腹股沟疝修补术后的镇痛效果较好,利于患者术后恢复,安全性好。Objective To explore and analyze the application value of ultrasound guided continuous iliohypogastric/ilioinguinal nerve block(IINB)in inguinal hernia repair in the elderly and its effect on the postoperative analgesia and recovery.Methods A total of 100 elderly patients with inguinal hernia who prepared to receive inguinal hernia repair treatment in the First Affiliated Hospital of Xi'an Medical University from Jan.2020 to Jul.2021 were included.According to the random number table method,the patients were divided into an observation group and a control group,with 50 cases in each group.The control group received epidural anesthesia,and the observation group received continuous IINB under ultrasound guidance.The heart rate and mean arterial pressure were measured and compared between the two groups at the time points of entry(T 0),5 minutes after the completion of the first anesthesia(T_(1)),skin incision(T_(2))and the end of operation(T_(3));visual analogue scale(VAS)was used to evaluate the analgesia immediately,6 h,12 h and 24 h after operation of the two groups;the time of operation,postoperative recovery activities and hospital stay,and the occurrence of adverse reactions in both groups were recorded.Results The main effects of heart rate and mean arterial pressure were significantly different between groups and time points(P<0.01),and there were interaction effects(P<0.01),at T_(1)-T_(2),heart rate and mean arterial pressure were decreased compared with T_(0),but increased at T_(3),and the heart rate and mean arterial pressure of the observation group at T_(1)-T_(3) were higher than those of the control group(P<0.05).There were statistically significant differences in the main effects of VAS between groups and time points(P<0.01),and there were interaction effects(P<0.01),the VSA scores at 6 h and 12 h after operation were increased than those immediately after operation,but decreased at 24 h after operation,and the VAS scores at 6 h and 12 h after operation in the observation group were lower than those

关 键 词：腹股沟疝修补术 超声引导 髂腹下-髂腹股沟神经阻滞 镇痛 术后恢复 

分 类 号：R656.21[医药卫生—外科学]