国际麻醉学与复苏杂志   2016, Issue (8): 9-9
    
超声引导下腹横肌平面阻滞与髂腹股沟及髂腹下神经阻滞在小儿腹股沟区手术应用的比较
薛杭, 丁萌萌, 孙楠, 赵平1()
1.中国医科大学附属盛京医院麻醉科
Ultrasound guided transversus abdominis plane block vs ilioinguinal/iliohypogastric nerve block after groin surgery in children: a prospective randomized clinical trial
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摘要:

目的 比较超声引导下腹横肌平面阻滞(transversus abdominis plane block, TAPB)与髂腹股沟及髂腹下神经阻滞(ilioinguinal/iliohypogastric nerve block, IINB)在小儿腹股沟区手术术中及术后早期的应用效果。 方法 选择择期进行单侧腹股沟区手术的患儿80例,年龄2~4岁,ASA分级Ⅰ级。按随机数余数法分为TAPB组和IINB组,每组40例。两组患儿均于全身麻醉下行超声引导下TAPB或超声引导下 IINB。分别观察与记录患儿的入室基础情绪,入室(T1)、切皮(T2)、缝皮(T3)时的HR、BP,手术时间、苏醒时间、PACU留观时间,改良加拿大东安大略儿童医院疼痛评分量表(modified children's hospital of eastern ontario pain scale, m-CHEOPS)评分、儿童麻醉后躁动评分(pediatric anesthesia emergence delirium, PAED)、PACU给药人数、术后恶心呕吐人数及患儿家长满意度。 结果 超声引导下TAPB组与IINB组在一般情况、基础情绪、局部麻醉药用量及入室的HR、BP方面差异无统计学意义(P>0.05)。IINB组患儿在PACU首次、10、20、30 min的m-CHEOPS评分都低于TAPB组,差异有统计学意义(P<0.05),并且PACU给药人数IINB组也低于TAPB组[IINB组6人(15%),TAPB组15人(39%)],差异有统计学意义(P<0.05);两组躁动发生率比较,差异没有统计学意义(P>0.05),但IINB组的PAED评分明显低于TAPB组{IINB组PAED评分[中位数(四份位数间距)]3(0~14),TAPB组PAED评分6(0~16)},差异有统计学意义(P<0.05);IINB组在术后恶心呕吐的发生率及家长满意度均低于TAPB组,但差异无统计学意义(P>0.05)。 结论 超声引导下,相比于TAPB,IINB能为腹股沟区术后的小儿提供更为安全、高效的镇痛,是小儿腹股沟区手术术后镇痛的较佳选择。

关键词: 超声引导下神经阻滞; 腹横肌平面阻滞; 髂腹股沟及髂腹下神经阻滞; 小儿; 术后
Abstract:

Objective To compare the efficacy of ultrasound guided transversus abdominis plane block(TAPB) and ilioinguinal/iliohypogastric nerve block(IINB) in providing postoperative analgesia after children groin surgery. Methods Eligible children, 2-4 years old (n=80), ASA Ⅰ, undergoing elective unilateral groin surgery, were randomly assigned into IINB group (ultrasound guided ilioinguinal-iliohypogastric nerve block after routine general anesthesia) and TAPB group (ultrasound guided transversus abdominis plane block after routine general anesthesia). Funk sedation scores, intraoperative HR, BP at time points of before induction (T1), skin incision(T2) and skin closure(T3), length of surgery, the time from PACU arrival to the first obtainable pain score, length of PACU stay, modified children's hospital of eastern ontario pain scale(m-CHEOPS) pain scores, pediatric anesthesia emergence delirium(PAED) scores, number of children with sufentanil administered in PACU, number of people occurred nausea and vomiting, satisfaction of parents were measured and recorded during the study. Results There was no significant difference in general characteristics, basic emotion score, local anesthetic dose and the haemodynamic parameter between the IINB group and TAPB group(P>0.05). However, the m-CHEOPS scores at the time points of first obtainable, 10, 20, 30 min in IINB group were lower than those in TAPB group(P<0.05), and the number of children received sufentanil administration in IINB group were less than in TAPB group[IINB group: 6 children (15%), TAPB group: 15 children(39%)](P<0.05). There was no statistical significant difference in the occurrence rate of delirium between the two groups(P>0.05), whereas the PAED score of IINB group was lower than that in TAPB group[IINB group PAED score(median,inter-quartile range): 3(0-14), TAPB group PAED score: 6(0-16)] (P<0.05). The occurrence rate of nausea and vomiting in IINB group were also lower than that in TAPB group, but there was no statistical difference(P>0.05). Conclusions Ultrasound guided IINB could provide more secure and efficient postoperative analgesia in children after groin surgery.

Key words: Ultrasound guided nerve block; Transversus abdominis plane block; Ilioinguinal/iliohypogastric nerve block; Pediatric; Postoperative analgesia