超声引导下髂腹股沟—生殖股神经联合阻滞对睾丸显微取精术镇痛效果的影响  

Effects of ultrasound-guided ilioinguinal-genitofemoral nerve block on analgesia in testicular microspermectomy

作　　者：代山[1] 胡振华[1] 侯铁柱[1] 崔明珠[1] 刘胜群[1] DAI Shan;HU Zhenhua;HOU Tiezhu;CUI Mingzhu;LIU Shengqun(Department of Anesthesiology and Perioperative Medicine,Henan Province People's Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院麻醉与围术期医学科,郑州市450003

出　　处：《临床麻醉学杂志》2022年第10期1061-1065,共5页Journal of Clinical Anesthesiology

摘　　要：目的观察髂腹股沟-生殖股神经联合阻滞对无精症患者显微镜下睾丸切开取精术镇痛效果和应激反应的影响。方法择期行显微镜下睾丸切开取精术患者60例,年龄22~45岁,BMI 20~30 kg/m^(2),ASAⅠ或Ⅱ级,采用随机数字表法分为两组:全身麻醉联合神经阻滞组(观察组)和全身麻醉组(对照组),每组30例。观察组在麻醉诱导前于超声引导下行髂腹股沟神经和生殖股神经生殖支阻滞,分别注射0.5%罗哌卡因0.25 ml/kg和5 ml。两组常规麻醉诱导置入喉罩机械通气,丙泊酚、瑞芬太尼麻醉维持。记录术中丙泊酚和瑞芬太尼用量、苏醒期高血压和心动过速发生情况;记录术后恶心呕吐及24 h内帕瑞昔布钠补救镇痛情况;记录苏醒后2、6、12、24 h静息和运动时VAS疼痛评分;并于手术前、切皮后5 min、还纳睾丸即刻和术后6、12 h,采集静脉血测定血浆去甲肾上腺素(NE)和肾上腺素(E)浓度。结果与对照组比较,观察组丙泊酚和瑞芬太尼用量明显减少,苏醒期高血压和心动过速发生率明显降低,术后恶心呕吐及帕瑞昔布钠补救率明显降低,术后2、6、12 h静息及运动VAS疼痛评分明显降低,在切皮后5 min、还纳睾丸即刻和术后6、12 h静脉血E、NE浓度明显降低(P<0.05)。结论髂腹股沟-生殖股神经联合阻滞用于无精症患者显微镜下睾丸切开取精术,具有良好的镇痛效果,可减少术中全麻及镇痛药物用量,抑制术后应激反应及心血管反应。Objective To evaluate the efficacy of ultrasound-guided combined ilioinguinal and genitofemoral nerve block for postoperative analgesia and stress reaction in patients undergoing microdissection testicular sperm extraction.Methods Sixty patients,aged 22-45 years,BMI 20-30 kg/m^(2),ASA physical statusⅠorⅡ,were randomly divided into two groups:general anesthesia combined with nerve block group(observation group)and general anesthesia group(control group),with 30 patients in each group.Before anesthesia induction,the ilioinguinal nerve and the genital branch of the genitofemoral nerve in the observation group were blocked by ultrasound-guidance,and 0.5%ropivacaine 0.25 ml/kg and 5 ml were injected,respectively.In both groups,mechanical ventilation was placed into the laryngeal mask for routine anesthesia induction,and anesthesia was maintained with propofol and remifentanil.The dosage of propofol and remifentanil during operation,the incidence of hypertension and tachycardia during recovery were recorded.Postoperative nausea and vomiting and parecoxib sodium analgesic recovery rate within 24 h after operation were recorded.VAS scores of resting and exercise at 2 h,6 h,12 h and 24 h after resuscitation were recorded.Venous blood samples were collected before operation,5 min after skin excision,immediately after testis reinsertion and 6 h,12 h after operation.Plasma concentrations of norepinephrine(NE)and epinephrine(E)were determined by ELISA.Results Compared with the control group,the dosage of propofol and remifentanil was decreased,the incidence of waking-stage hypertension and tachycardia was significantly decreased,the incidence of postoperative nausea and vomiting and parecoxib sodium remedial cases were significantly decreased,the resting and exercise VAS scores were significantly decreased at 2,6,and 12 h after surgery,the levels of E and NE in venous blood were significantly decreased 5 min after skin resection,immediately after testis reinsertion,and 6 and 12 h after surgery in the observation group(P<0

关 键 词：超声引导 髂腹股沟神经 生殖股神经 显微取精术 镇痛 应激反应 

分 类 号：R614[医药卫生—麻醉学]