骶管阻滞在小儿斜疝结扎术中应用的研究

发布时间：2018-06-18 08:21

本文选题：腹股沟斜疝 + 骶管阻滞　；参考：《兰州大学》2014年硕士论文

【摘要】：目的许多研究评价了术前骶管阻滞对小儿腹股沟斜疝高位结扎术术后疼痛的影响,但是这些研究均未报告患儿术后身体恢复情况以及相关经济学指标。本研究旨在采用历史性队列研究的方法,评价静脉麻醉联合骶管阻滞对腹股沟斜疝高位结扎术患儿术后恢复的影响及相关经济成本,为骶管阻滞的临床应用提供客观依据。方法采用历史性队列研究的方法,根据诊断标准、纳入和排除标准筛选2011年6月至2013年6月在兰州大学第一医院小儿外科接受腹股沟斜疝高位结扎术的小儿病例。根据所使用的麻醉方式,将纳入的患儿分为静脉麻醉组(单纯静脉麻醉)和联合麻醉组(静脉麻醉联合骶管阻滞),比较两组患儿术后住院时间、术后并发症、住院费用、术中及术后药物的使用情况、麻醉时间和手术时间。采用SPSS19.0软件进行统计分析。结果共纳入113例患儿,其中包括静脉麻醉组53例,联合麻醉组60例。两组患儿在年龄、体重、斜疝类型方面差异无统计学意义,基线具有可比性。两组在术后住院时间、术后阴囊水肿及上呼吸道感染发生率方面差异无统计学意义,且两组均未出现切口出血、切口感染及斜疝复发。两组在住院总费用、床位费及手术费方面差异无统计学意义,在麻醉费用、药护费用、检查费和治疗费方面差异有统计学意义。两组在术中氯胺酮的使用率和使用量以及术后止血芳酸、抗生素、抗病毒药物、止痛药和止吐药使用率方面差异无统计学意义,在术中芬太尼的使用率和使用量、丙泊酚的使用率以及术后止血芳酸的使用量方面差异有统计学意义。两组在手术时间及麻醉时间方面差异无统计学意义。结论静脉麻醉联合骶管阻滞可以减少小儿腹股沟斜疝高位结扎术术中麻醉药物的使用,但对患儿术后住院时间和术后恢复无影响；在医疗费用方面,虽然联合骶管阻滞可以增加麻醉费用,但可减少其他相关费用,对住院总费用无影响。由于历史性队列研究的局限性,本研究结论还需要前瞻性研究进一步验证。
[Abstract]:Objective to evaluate the effect of preoperative sacral canal block on pain after high ligation of indirect inguinal hernia in children. The purpose of this study was to evaluate the effect of intravenous anesthesia combined with sacral canal block on recovery and related economic cost of high ligation of indirect inguinal hernia in children with indirect inguinal hernia by using the method of historical cohort study, and to provide an objective basis for the clinical application of sacral canal block. Methods A historical cohort study was used to select children who underwent high ligation of indirect inguinal hernia from June 2011 to June 2013 in pediatric surgery of Lanzhou University first Hospital according to diagnostic criteria. According to the anesthetic method used, the children were divided into intravenous anesthesia group (simple intravenous anesthesia) and combined anesthesia group (intravenous anesthesia combined with sacral canal block). Intraoperative and postoperative drug use, anesthetic time and operation time. SPSS 19.0 software was used for statistical analysis. Results 113 cases were included, including 53 cases in intravenous anesthesia group and 60 cases in combined anesthesia group. There was no significant difference in age, body weight and type of indirect hernia between the two groups, and the baseline was comparable. There was no significant difference in postoperative hospital stay, scrotal edema and upper respiratory tract infection between the two groups, and there was no incision bleeding, wound infection and recurrent hernia in both groups. There was no significant difference between the two groups in total hospital expenses, bed fees and operating expenses, but there were significant differences in the cost of anesthesia, drug care, examination and treatment. There was no significant difference between the two groups in the usage and usage of ketamine during operation, as well as in the use of hemostatic acid, antibiotics, antiviral drugs, painkillers and antiemetic drugs, but the usage and usage of fentanyl during the operation. There were significant differences in the usage of propofol and the use of hemostatic acid after operation. There was no significant difference in operation time and anesthesia time between the two groups. Conclusion intravenous anesthesia combined with sacral block can reduce the use of anesthetic during high ligation of indirect inguinal hernia in children, but it has no effect on hospital stay and postoperative recovery. Although combined sacral block can increase the cost of anesthesia, it can reduce other related costs and has no effect on the total cost of hospitalization. Due to the limitations of the historical cohort study, the findings of this study need to be further validated by prospective studies.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R726.1

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