超声引导与体表定位用于肥胖患儿阴茎成形术骶管阻滞的比较  

Comparison of ultrasound guidance and body surface positioning for caudal block in obese children undergoing phalloplasty

作　　者：胡祖烨 于布为[1] 董榕[1] 沈子珒[1] 王海滨[1] 王智渊 HU Zuye;YU Buwei;DONG Rong;SHEN Zijin;WANG Haibin;WANG Zhiyuan(Department of Anesthesiology,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 201800,China)

机构地区：[1]上海交通大学医学院附属瑞金医院麻醉科,201800

出　　处：《临床麻醉学杂志》2025年第2期165-168,共4页Journal of Clinical Anesthesiology

基　　金：嘉定区农业和社会事业科研项目(JDKW-2019-W11)。

摘　　要：目的 比较肥胖患儿阴茎成形术中超声引导与体表定位行骶管阻滞的效果。方法选择全麻联合骶管阻滞下行阴茎成形术的肥胖患儿100例,年龄5~12岁,BMI大于同龄儿童BMI第95百分位数,ASAⅠ级。采用随机数字表法将患儿随机分为两组:体表定位组(C组)和超声引导组(U组),全麻置入喉罩后分别采用0.3%罗哌卡因0.7 ml/kg实施体表定位骶管阻滞或超声引导骶管阻滞。记录阻滞成功例数、阻滞操作时间、穿刺次数、首次穿刺成功例数、总穿刺成功例数、术后1 h的面部表情疼痛量表(FLACC)评分、术后8 h内布洛芬镇痛例数。记录脊麻、局麻药中毒、穿刺回抽见血及药物注射时皮下组织突出等不良事件的发生情况。结果 与C组比较,U组阻滞成功率、首次穿刺成功率和总穿刺成功率明显升高(P<0.05),术后8 h内布洛芬镇痛率、药物注射时皮下组织突出发生率明显降低(P<0.05)。两组阻滞操作时间、术后1 h的FLACC评分、穿刺回抽见血发生率差异无统计学意义。两组无一例脊麻和局麻药中毒情况。结论 在接受阴茎成形术的肥胖患儿中,与体表定位比较,超声引导行骶管阻滞成功率更高且穿刺并发症发生率更低。Objective To compare the effect of ultrasound guidance and body surface positioning for caudal block in obese children undergoing phalloplasty.Methods A total of 100 obese children aged 5-12 years,BMI greater than the 95th percentile for a child of the same age,ASA physical statusⅠ,were selected for penile deformity correction under general anesthesia combined with caudal block.The children were randomly divided into two groups by random number table method:body surface positioning group(group C)and ultrasound-guided group(group U).After laryngeal mask airway-induced general anesthesia,0.3%ropivacaine 0.7 ml/kg was used for caudal block by ultrasound guidance or body surface positioning.The success cases of caudal block,the operation time,the number of punctures,the first puncture success case,the total puncture success cases,the face,legs,activity,cry and consolability scale(FLACC)score 1 hour after surgery,and the need for intraibuprofen analgesia within 8 hours after surgery were recorded.The adverse events such as spinal anesthesia,local anesthetic poisoning,blood from puncture withdrawal,and subcutaneous tissue protrusion during drug injection were recorded.Results Compared with group C,group U had significantly higher success rates of sacral block,first puncture success,and total puncture success(P<0.05),a significantly lower need for ibuprofen analgesia,as well as a lower incidence rate of subcutaneous tissue protrusion during drug injection(P<0.05).There was no significant difference in the operation time,FLACC score at 1 hour postoperatively,and blood found in puncture extractio between the two groups.There was no case of spinal anesthesia and local anesthetic poisoning in the two groups.Conclusion Compared with body surface positioning,ultrasound-guided caudal block has a higher success rate and a lower incidence of puncture complications in obese children undergoing phalloplasty.

关 键 词：超声成像 骶管阻滞 肥胖 小儿 阴茎成形术 

分 类 号：R726.1[医药卫生—儿科]