超声引导下IINB复合全麻用于儿童腹股沟疝日间手术效果观察

发布时间：2018-05-28 14:47

本文选题：腹股沟疝 + 超声　；参考：《山东医药》2017年04期

【摘要】：目的探讨超声引导下骼腹股沟—髂腹下神经联合阻滞(IINB)复合全麻用于儿童腹股沟疝日间手术的可行性。方法选择1~5岁腹股沟疝患儿40例,随机分为体表定位组和超声引导组,每组20例。体表定位组采用Schulte-Steinbery法体表定位行IINB,超声引导组于超声引导下行IINB。观察两组切皮时和结扎疝囊时体动情况,统计术中追加丙泊酚的患儿例数;记录入室即刻、诱导结束时、切皮完成时、结扎疝囊即刻、术毕及苏醒时HR和平均动脉压(MAP);记录术后麻醉恢复室(PACU)内滞留时间,统计滞留期间出现呕吐、穿刺点出血或血肿、局麻药入血或延迟苏醒的患儿例数,出PACU进行东安大略儿童医院疼痛评分(CHEOPS评分)。结果体表定位组切皮时出现体动12例、术中追加丙泊酚14例,超声引导组分别为5、6例,两组比较P均0.05。超声引导组切皮完成时、结扎疝囊即刻、苏醒时HR均低于体表定位组(P0.05或0.01)。体表定位组、超声引导组各有2例在PACU内滞留期间出现呕吐,均未出现穿刺点出血或血肿、局麻药入血及延迟苏醒等情况。两组PACU内滞留时间比较P0.05;出PACU时体表定位组及超声引导组CHEOPS评分分别为(7.05±1.47)、(5.30±0.92)分,两组比较P0.01。结论超声引导下IINB复合全麻用于儿童腹股沟疝日间手术麻醉效果好,且效为安全。
[Abstract]:Objective to investigate the feasibility of combined iliac groin and inferior iliac nerve block (IINB) combined with general anesthesia guided by ultrasound for daytime operation of inguinal hernia in children. Methods 40 children with inguinal hernia aged 1 to 5 years were randomly divided into body surface localization group and ultrasound guided group, 20 cases in each group. Schulte-Steinbery method was used to locate the body surface in the body surface localization group. To observe the body movement during incision and ligation of hernia sac, and to count the number of children who received propofol during operation, and to record the number of children with hernia sac ligated immediately, at the end of induction, at the end of incision, and at the end of ligation of hernia sac. HR and mean arterial pressure MAPU were recorded at the end of operation and recovery, and the number of children with vomiting, bleeding or hematoma at puncture point, local anesthetic injection or delayed recovery were recorded. PACU was used to evaluate the pain score of Eastern Ontario Children's Hospital (EOPS). Results there were 12 cases of body movement, 14 cases of intraoperative propofol, and 6 cases of ultrasound guided group (P < 0.05). The HR of the ultrasonic guided group was lower than that of the body surface positioning group (P0.05 or 0.01) at the moment of ligation of hernia sac and at the time of awakening. There were 2 cases of vomiting in the PACU group and 2 cases in the ultrasound guided group. There were no bleeding or hematoma at the puncture point, local anesthetic injection and delayed recovery. The CHEOPS scores of body surface localization group and ultrasound guided group were 7.05 卤1.47 and 5.30 卤0.92, respectively. Conclusion Ultrasound-guided IINB combined with general anesthesia is effective and safe in the treatment of inguinal hernia in children.
【作者单位】：首都医科大学附属北京儿童医院;
【基金】：基金项目:首都临床特色应用研究与成果推广(Z161100000516142)
【分类号】：R726.1

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