摘要
目的探究超声引导髂腹股沟-髂腹下神经联合阻滞(IINB)与全身麻醉对腹股沟疝手术患儿生理参数的影响。方法选取2017年2月至2018年10月,解放军空降兵军医院麻醉科进行开放式腹股沟疝疝囊内环高位结扎术的患儿110例。随机分为对照组和观察组,每组55例。对照组患儿采用单纯全身麻醉,观察组患儿对照组基础上增加IINB。观察并比较2组患儿手术情况、不良反应及生理参数、免疫应激水平。术后麻醉恢复室(PACU)内滞留时间、苏醒时间、手术时间、以及免疫应激水平指标等计量资料,采用均数±标准差(x±s)来表示,独立样本t检验进行比较。术后不良反应如呕吐、穿刺点出血或血肿、局麻药入血或延迟苏醒的患儿例数等为计数资料,采用率表示,χ2检验进行比较。以P<0.05表示差异有统计学意义。结果观察组腹股沟疝患儿不良反应发生情况为6例(10.91%),对照组为4例(7.72%),差异无统计学意义(P>0.05)。观察组腹股沟疝患儿术后PACU滞留时间、苏醒时间和手术时间分别为(8.63±1.97)min、(3.42±0.67)min、(28.31±3.23)min,与对照组(9.79±2.58)min、(3.49±0.52)min、(27.83±2.77)min比较,差异均无统计学意义(P>0.05)。术后苏醒时观察组患儿心率(HR)及平均动脉压(MAP)分别为(88.72±13.16)次/min、(64.25±4.64)mmHg,与对照组(94.17±10.11)次/min、(67.16±4.71)mmHg比较,差异均有统计学意义(P<0.05);术后6 h观察组患儿HR及MAP分别为(85.51±10.31)次/min、(63.10±3.89)mmHg,与对照组(89.88±11.23)次/min、(65.14±5.21)mmHg比较,差异均有统计学意义(P<0.05)。术后苏醒时,观察组腹股沟疝患儿皮质醇(Cor)、白介素-6(IL-6)水平分别为(14.68±2.73)mmol/L、(5.92±1.64)pg/L,与对照组(19.12±3.29)mmol/L、(11.03±2.07)pg/L比较,差异均有统计学意义(P<0.05);术后6 h,观察组腹股沟疝患儿皮质醇(Cor)、白介素-6(IL-6)水平分别为(13.42±2.64)mmol/L、(4.59±1.28)pg/L,与对照组(17.69±3.16)mmol/L、(7.23±2.21)pg/L比较,差异均有统计学意义(P<0.05)。结论在全身麻醉基础上,联合超声引导IINB对腹股沟疝手术患儿不会增加患儿术后不良反应的发生率,但其术后应激反应影响小,患儿生命体征更为平稳。
Objective To explore the effect on physiological parameters of children with inguinal hernia surgery by using ultrasound-guided ilioinguinal-iliohypogastric nerve block(IINB)and general anesthesia.Methods From February 2017 to October 2018,110 children undergoing open high ligation of hernial sac for inguinal hernia surgery in PLA Airborne Army Hospital were randomly divided into the control group and the observation group,with 55 cases in each group.The control group was treated with general anesthesia only,while the observation group was treated with INNB on the basis of the control group.The operation conditions,adverse reactions and physiological parameters,the level of immune stress were observed and compared between the two groups.Results The incidence of adverse reactions was 10.91%(n=6)in the observation group and 7.72%(n=4)in the control group,and there was no significant difference between the two groups(P>0.05).There was no significant difference in retention time in postoperative anesthesia recovery room after operation,recovery time and operation time between the two groups(P>0.05).The levels of the heart rate and mean arterial pressure of the children in the observation group were lower than those in the control group at the time to wake up and 6 hours after operation(P<0.05).The levels of cortisol and interleukin-6 in the observation group were lower than those in the control group when waking up and 6 hours after operation(P<0.05).Conclusion On the basis of general anesthesia,combined with ultrasound-guided IINB will not increase the incidence of postoperative adverse reactions in children with inguinal hernia surgery,but its postoperative stress response has little influence and the vital signs of children are more stable.
作者
杨振龙
吴纯东
左东
Yang Zhenlong;Wu Chundong;Zuo Dong(Department of Anesthesiology,PLA Airborne Army Hospital,Wuhan 430012,China;Department of General Surgery,PLA Airborne Army Hospital,General Surgery,Wuhan 430012,China)
出处
《中华疝和腹壁外科杂志（电子版）》
2020年第2期138-141,共4页
Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)
基金
湖北省卫生健康科研基金资助项目(WJ2018F132)。
