摘要
目的:探讨腹腔镜引导下腹膜前间隙阻滞用于小儿腹股沟斜疝疝囊高位结扎术术后镇痛的新方法.方法:33例全麻腹股沟斜疝患儿,主刀医生在腹腔镜引导下用疝气针分离患侧腹膜前间隙游离精索的同时,注入 0.2%罗哌卡因0.5 ml/kg,观察并记录患儿不同时间点的血流动力学指标、气道压、二氧化碳分压(PaCO2)、手术时间、麻醉时间、苏醒时间、术后镇痛时间、麻醉及手术并发症、改良警觉/镇静观察评估法(MOAA/S)评分、采用FLACC评分评估疼痛情况.结果:不同时间点收缩压、舒张压、平均动脉压、SpO2 等血流动力学指标差异无统计学意义(P>0.05);平均麻醉时间为(39.21±4.49)min,手术时间(20.15±3.96)min,苏醒时间(7.73±2.76)min;插管后、手术开始时、手术结束时PaCO2 差异无统计学意义(P>0.05);气道压手术开始时>手术结束时>插管后;手术结束、术后 2 min、术后 4 min、术后 6 min、术后 8 min、术后 10 min的MOAA/S评分为:(0.30±0.88)、(1.18±1.38)、(2.48±1.50)、(3.30±1.36)、(4.48±0.80)、(4.97±0.17)分;拔管时、术后6 h、12 h、24 h的FLACC评分为:(0.36±1.03)、(0.45±0.67)、(1.27±0.84)、(1.36±0.60)分;术后镇痛时间(12.09±3.49)h;未见麻醉及手术并发症.结论:腹腔镜引导下患侧腹膜前间隙注入 0.2%罗哌卡因 0.5 ml/kg,小儿腹股斜沟疝疝囊高位结扎术术后镇痛安全、有效.
Abstract
Objective To explore the effect of laparoscopic guided preperitoneal space block(LSgPSB)in laparoscopic high ligation of hernia sac in children.Method 33 children with inguinal hernia were recruited,they were treated with 0.2%ropivacaine 0.5 ml/kg while the surgeon used a hernia needle under laparoscopic guidance to separate the free spermatic cord in the anterior peritoneal space.Record the hemodynamic indicators,airway pressure,PETCO2,surgical time,extubation time,postoperatively analgesic time,anesthesia and surgical complications,MOAA/S score,and FLACC score at different time points.Results There was no significant difference in hemodynamic indicators such as systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),and SPO2 at different time points(P>0.05).The average anesthesia time was 39.21±4.49 minutes,the surgical time was 20.15±3.96 minutes,and the extubation time was 7.73±2.76 minutes.There was no significant difference in PETCO2 at different time points(P>0.05).The order of airway pressure was at the beginning of surgery>at the end of surgery>after intubation.The MOAA/S scores at the end of surgery,2 minutes after surgery,4 minutes,6 minutes,8 minutes,and 10 minutes were 0.30±0.88、1.18±1.38、2.48±1.50、3.30±1.36、4.48±0.80、4.97±0.17.The FLACC scores at extubation,6h,12h,and 24h after surgery were 0.36±1.03,0.45±0.67,1.27±0.84,and 1.36±0.60.Postoperatively analgesic time was 12.09±3.49 hours and no anesthesia or surgical complications were observed.Conclusion Laparoscopic guided injection of 0.2%ropivacaine 0.5ml/kg into the preperitoneal space can safely and effectively relieve postoperative pain in laparoscopic high ligation of hernia sac in children,and is worthy of clini-cal promotion.
维普
万方数据