纳布啡超前镇痛联合超声引导下腹直肌鞘阻滞应用于单孔腹腔镜小儿疝手术的效果  

Efficacy of ultrasound-guided rectus sheath block combined with naborphine preemptive analgesia in pediatric single hole endoscopic hernia surgery

作　　者：田迪 邱永升[1] 贾英萍 Tian Di;Qiu Yongsheng;Jia Yingping(Department of Anesthesia and Perioperative Medicine,Children's Hospital Affiliated to Zhengzhou University,Henan Children's Hospital,Zhengzhou Children's Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州大学附属儿童医院(河南省儿童医院郑州儿童医院)麻醉与围术期医学科,郑州450000

出　　处：《河南外科学杂志》2022年第6期18-20,共3页Henan Journal of Surgery

摘　　要：目的探讨纳布啡超前镇痛联合超声引导下腹直肌鞘阻滞应用于单孔腹腔镜小儿疝手术的效果。方法择期行全麻单孔腹腔镜疝手术患儿60例,采用随机数字表法分为2组,每组30例。2组均于术前行超声引导下腹直肌鞘阻滞,观察组在麻醉诱导前静注纳布啡0.2 mg/kg,对照组给予等量生理盐水。记录术中瑞芬太尼用量、术后拔除喉罩及在PACU停留时间。检测切皮前(T_(1))、切皮时(T_(2))、腹腔镜镜头固定后(T_(3))、手术结束时(T_(4)),以及转入PACU时(T 5)的HR和MAP。采用FLACC法评分评估患儿苏醒时及术后2、4、8、12 h的疼痛程度。统计需行挽救性镇痛的例数和不良反应发生率。结果2组患儿的拔除喉罩时间、PACU停留时间,术中及术后各时间点的MAP、HR的水平,术后12 h的FLACC评分,心动过缓不良反应率等指标的差异均无统计学意义(P>0.05)。观察组患者瑞芬太尼用量少于对照组,患儿苏醒即刻,术后2 h、4 h及8 h的FLACC评分低于对照组,需追加镇痛药物例数少于对照组,术后躁动不良反应发生率低于对照组。以上差异均有统计学意义(P<0.05)。结论对行单孔腹腔镜疝手术的患儿,采取超声引导下腹直肌鞘阻滞联合纳布啡超前镇痛,镇痛效果好,对患儿围术期的生命体征影响较小,并有利于降低术后躁动的发生率。Objective To investigate the effect of ultrasound-guided rectus sheath block combined with naborphine preemptive analgesia in single hole endoscopic hernia surgery in children.Methods A total of 60 children undergoing elective single hole laparoscopic hernia surgery under general anesthesia were divided into observation group and control group according to random number table,with 30 cases in each group.Both groups underwent ultrasound-guided rectus sheath block before surgery.In the observation group,0.2mg/kg naborphine was injected intravenously before anesthesia induction.The control group was given the same amount of normal saline.The amount of remifentanil used during the operation,the removal of laryngeal mask and PACU stay were recorded.HR and MAP were measured before skin incision(T_(1)),at the time of incision(T_(2)),after laparoscopic lens fixed(T_(3)),at the end of surgery(T_(4)),and at the time of PACU transfer(T 5).FLACC was used to evaluate the pain degree of the children when they woke up and 2,4,8,12 hours after surgery.The number of cases requiring rescue analgesia and the incidence of adverse reactions were counted.Results There was no significant difference between the two groups in terms of laryngeal removal,PACU stay,MAP and HR levels at various time points during and after surgery,FLACC at 12 hours after operation,and adverse reaction rate of bradycardia(P>0.05).Compared with the control group,the dosage of remifentanil,The FLACC scores at the moment of awakening,2h,4h,8h after operation,the number of cases requiring additional analgesic drugs and the incidence of agitation after operation was lower in the observation group,with statistical significance(P<0.05).Conclusion For children undergoing single hole laparoscopic hernia surgery,ultrasound-guided rectus sheath block combined with nalbuphine preemptive analgesia can provide an excellent analgesic effect,which has less impact on the perioperative vital signs of children and can reduce the incidence of postoperative agitation.

关 键 词：腹直肌鞘阻滞 纳布啡 超前镇痛 单孔腹腔镜 小儿疝手术 

分 类 号：R614.2[医药卫生—麻醉学]