超声引导下腹横肌平面阻滞复合喉罩全身麻醉在儿童手创伤腹部皮瓣修复术中的应用  

Application of ultrasonic transverse abdominal muscle block in abdominal skin flap repair of hand injury in children

作　　者：刘冬 程森 刘珊珊 肖平侠 LIU Dong;CHENG Sen;LIU Shan-shan;XIAO Ping-xia(Department of Anesthesiology,73rd Army Hospital of PLA,Success Hospital Affiliated to Xiamen University;Department of Anesthesiology,Xiamen Renjun Hospital,Xiamen,Fujian 361000)

机构地区：[1]中国人民解放军陆军第73集团军医院厦门大学附属成功医院麻醉科 [2]厦门仁军医院麻醉科,福建厦门361000

出　　处：《赣南医学院学报》2023年第12期1245-1249,1274,共6页JOURNAL OF GANNAN MEDICAL UNIVERSITY

基　　金：厦门市科技计划指导性项目(3502Z20214ZD1186)。

摘　　要：目的:观察超声引导下腹横肌平面阻滞(Transversus abdominis plane block,TAPB)复合喉罩全身麻醉在儿童手创伤腹部皮瓣修复术中的麻醉效果。方法:选取2021年10月至2023年4月于中国人民解放军陆军第73集团军医院烧伤科严重手创伤拟行腹部皮瓣修复术60例患儿为研究对象,根据麻醉方式不同分为两组:超声引导下TAPB复合喉罩全身麻醉组(复合组)和单纯喉罩全身麻醉组(单纯组),每组30例。所有患儿均采用喉罩单纯静脉全身麻醉诱导,复合组患儿在全身麻醉置入喉罩后,在高频线阵探头超声引导下行单侧(拟皮瓣修复侧)入路即腋中线法TAPB,单侧注入0.25%罗哌卡因0.5 mL·kg^(-1)。对比两组患儿的麻醉效果、术后不良反应发生情况以及恢复情况。结果:与单纯组相比,复合组腹部手术开始后5 min、25 min和45 min的平均动脉压和心率均显著降低(P<0.05),腹部手术中瑞芬太尼及丙泊酚使用剂量明显减少(P<0.05),拔除喉罩后5 min的Wong-Baker FACES评分也降低(P<0.05)。两组在恢复室的留观时间差异无统计学意义(P>0.05)。与单纯组相比,复合组在恢复室发生补救镇痛和术后躁动的比例显著降低(P<0.05)。两组呼吸抑制的发生率较低且差异无统计学意义(P>0.05)。结论:在儿童手创伤腹部皮瓣修复术中,应用超声引导下TAPB复合喉罩全身麻醉可显著提高术中镇痛效果,有效减少术中瑞芬太尼、舒芬太尼和丙泊酚使用剂量,并可减少术后不良反应的发生。Objective:To observe the anesthetic effect of ultrasound-guided transverse abdominis plane block(TAPB)combined with laryngeal mask airway general anesthesia in the repair of abdominal skin flap in children with hand injury.Methods:From October 2021 to April 2023,60 children who were scheduled to undergo abdominal flap repair in the burn department of 73rd Army Hospital of PLA were selected as the research objects.They were randomly divided into two group saccording to different anesthesia methods:TAPB combined with laryngeal mask airway under ultrasound guidance(composite group)and laryngeal mask airway alone(simple group),with 30 cases in each group.All the children were induced by laryngeal mask airway simple intravenous general anesthesia.After laryngeal mask airway was inserted under general anesthesia,the children in group T were injected with 0.25% ropivacaine(0.5 mL·kg^(-1))under the guidance of high-frequency linear array probe ultrasound.The anesthetic effect,postoperative adverse reactions and recovery of the two groups were compared.Results:Compared with group C,the average arterial pressure and heart rate were significantly decreased at 5 min,25 min and 45 min after the start of abdominal surgery(P<0.05),the dosage of remifentanil and propofol in group T was significantly reduced(P<0.05),and the Wong-BakerFACES score was significantly improved at 5 min after the laryngeal mask was removed(P<0.05).However,the time staying in the recovery room of the two groups was with no statistical significance(P>0.05).Compared with simple group,the incidence of remedial analgesia and postoperative restlessness in the recovery room in composite group was significantly lower(P<0.05).The incidence of respiratory depression in the two groups was lower and there was no statistical difference(P>0.05).Conclusion:The application of TAPB combined with laryngeal mask airway general anesthesia can significantly improve the analgesic effect during operation,effectively reduce the dosage of remifentanil,sufentanil and propofol

关 键 词：腹横肌平面阻滞 儿童 手创伤 全身麻醉 腹部皮瓣修复术 

分 类 号：R614.2[医药卫生—麻醉学]