超声引导下腹横肌平面阻滞对行腹腔镜修补术腹股沟斜疝患儿的麻醉效果
Anesthetic effect of ultrasound guided transverse abdominal muscle plane block in children with indirect inguinal hernia undergoing laparoscopic repair
冯龙杰 1陈三冬 2张伟3
作者信息
- 1. 汝州市人民医院(河南汝州 467599)
- 2. 河南省儿童医院(河南郑州 450003)
- 3. 郑州市中心医院(河南郑州 450007)
- 折叠
摘要
目的 研究超声引导下腹横肌平面阻滞联合全麻对行腹腔镜修补术的腹股沟斜疝患儿麻醉效果、疼痛程度、炎性应激、免疫功能的影响.方法 选取我院2018年9月至2021年2月接收的行腹腔镜修补术的腹股沟斜疝患儿92例,根据麻醉方案不同,分为全麻组(n=46)、超声局麻联合全麻组(n=46).两组均行腹腔镜下腹股沟疝修补术,全麻组予以静脉全麻,超声局麻联合全麻组予以超声引导下腹横肌平面阻滞联合静脉全麻.比较两组苏醒情况,术后2h、6h、12h、24h疼痛程度(FLACC评分),T0(麻醉前)、T1(术后即刻)、T2(术后12h)炎性应激指标、细胞免疫功能及不良反应情况.结果 超声局麻联合全麻组苏醒时间、自主呼吸时间、PACU停留时间及拔管时间短于全麻组(P＜0.05);术后2h、6h、12h、24h,超声局麻联合全麻组FLACC评分低于全麻组(P＜0.05);T1、T2时间,超声局麻联合全麻组白介素-6(IL-6)、皮质醇(Cor)、去甲肾上腺素(NE)水平低于全麻组(P＜0.05);T1、T2时间,超声局麻联合全麻组T淋巴细胞(CD4+)、CD4+/CD8+水平高于全麻组,调节T淋巴细胞(CD4+CD25+)水平低于全麻组(P＜0.05);超声局麻联合全麻组不良反应总发生率(8.70％)低于全麻组(3.921％)(P＜0.05).结论 腹股沟斜疝患儿行腹腔镜下腹股沟疝修补术中应超声引导下腹横肌平面阻滞联合全麻能有效缓患儿术后疼痛,减轻炎性应激反应程度,改善患儿免疫功能,缩短麻醉苏醒的时间,提高手术的安全性.
Abstract
Objective To study the effects of ultrasound guided transverse abdominal muscle block combined with gen-eral anesthesia on the anesthetic effect,pain degree,inflammatory stress and immune function of children with indirect ingui-nal hernia undergoing laparoscopic repair.Methods 92 children with indirect inguinal hernia who received laparoscopic repair from September 2018 to February 2021 in our hospital were selected and divided into general anesthesia group(n=46)and ultrasonic local anesthesia combined with general anesthesia group(n=46)according to different anesthesia schemes.Laparoscopic inguinal hernia repair was performed in both groups.The general anesthesia group was given intrave-nous general anesthesia,and the ultrasonic local anesthesia combined with general anesthesia group was given ultrasonic guided transverse muscle plane block combined with intravenous general anesthesia.The two groups were compared in terms of recovery,pain degree(FLACC score)at 2h,6h,12h and 24h after operation,T0(before anesthesia),T1(immediately after operation)and T2(12h after operation)inflammatory stress indicators,cellular immune function and adverse reactions.Re-sults The recovery time,spontaneous respiration time,PACU stay time and extubation time of the ultrasonic local anesthe-sia combined with general anesthesia group were shorter than those of the general anesthesia group(P＜0.05);At 2h,6h,12h,24h after operation,FLACC score of ultrasonic local anesthesia combined with general anesthesia group was lower than that of general anesthesia group(P＜0.05);At T1 and T2,the levels of interleukin-6(IL-6),cortisol(Cor)and noradrena-line(NE)in ultrasonic local anesthesia combined with general anesthesia group were lower than those in general anesthesia group(P＜0.05);At T1 and T2 time,the levels of T lymphocytes(CD4+)and CD4+/CD8+in the group of ultrasonic local anesthesia combined with general anesthesia were higher than those in the group of general anesthesia,and the levels of reg-ulating T lymphocytes(CD4+CD25+)were lower than those in the group of general anesthesia(P＜0.05);The total inci-dence of adverse reactions in ultrasonic local anesthesia combined with general anesthesia group(8.70％)was lower than that in general anesthesia group(3.921％)(P＜0.05).Conclusion Ultrasound guided transverse abdominal muscle block combined with general anesthesia in laparoscopic inguinal hernia repair for children with indirect inguinal hernia can effec-tively relieve the postoperative pain,reduce the degree of inflammatory stress reaction,improve the immune function of chil-dren,shorten the time of recovery from anesthesia,and improve the safety of surgery.
关键词
静脉全麻/腹横肌平面阻滞麻醉/腹股沟斜疝/应激反应/细胞免疫功能Key words
General intravenous anesthesia/Transverse abdominal muscle plane block anesthesia/Inguinal hernia/Stress reaction/Cellular immune function引用本文复制引用
出版年
2024
NETL
NSTL
万方数据