全麻联合不同阻滞方案对小儿精索鞘膜积液手术麻醉效果和恢复质量的影响-现代医学

全麻联合不同阻滞方案对小儿精索鞘膜积液手术麻醉效果和恢复质量的影响

单位：徐州市中心医院麻醉科, 江苏徐州 221000

分类号：R614.2

出版年·卷·期（页码）：2022·50·第一期（75-79）

摘要：

目的：对比小儿精索鞘膜积液手术中选用全麻联合腹横肌平面阻滞、全麻联合骶管阻滞两种麻醉方案的效果及对血流动力学波动预防价值。方法：收集本院在2018年1月至2019年1月收治的64例精索鞘膜积液患儿临床资料作为对象，按照麻醉方式不同进行分组。32例行全麻+骶管阻滞麻醉患儿作为对照组，32例行全麻+腹横肌平面阻滞患儿作为观察组。回顾分析患儿血流动力学指标变化、麻醉效果、术后苏醒和术后镇痛效果等情况。结果：观察组患者血管活性药物和镇痛药物使用率明显低于对照组(P＜0.05)，且观察组患儿术中麻醉药物使用剂量低于对照组(P＜0.05)；观察组麻醉后T₁~T₃的收缩压(SBP)、舒张压(DBP)水平及心率(HR)波动均显著小于对照组(P＜0.05)；观察组术后平均苏醒时间、完全清醒时间均短于对照组，差异有统计学意义(t=3.547、4.279，P＜0.05)；对照组、观察组术后不良反应发生率分别为3.13%、0%，差异无统计学意义(χ²=1.015，P＞0.05)；观察组术后2、4、8、12 h的客观疼痛评分法(OPS)评分相比对照组均明显更低，差异有统计学意义(P＜0.05)，两组24、48 h时OPS评分比较，差异无统计学意义(P＞0.05)。结论：全麻联合骶管阻滞或腹横肌平面阻滞均可以用于小儿精索鞘膜积液腹腔镜手术，有效减轻患儿血流动力学波动，不良反应少，但全麻+腹横肌平面阻滞方案组患儿术后苏醒时间更短，且术后镇痛效果更加理想。

Objective:To compare the effect of two anesthesia schemes of general anesthesia and the preventive value of hemodynamic fluctuation. Methods:The clinical data of 64 patients with spinal cord sheath membrane effusion admitted from January 2018 to January 2019 were collected and grouped according to different anesthesia methods.32 children with routine anesthesia with general anesthesia+sacral tube block were used as control group, and 32 children with wanted general anesthesia+abdominal transverse muscle plane block were used asobservation group. The hemodynamic changes of hemodynamic indicators, anesthesia effect, postoperative awakening and postoperative analgesia were reviewed and analyzed. Results:The incidence of vasoactive drug and analgesic dosage in the observation group was significantly lower than that in the control group(P＜0.05), And the intraoperative anesthetic dose of the children in the observation group was lower than that in the control group(P＜0.05); SBP, DBP levels and HR fluctuations at T₁~T₃ after anesthesia were significantly smaller than in the control group(P＜0.05); The average postoperative awake time and fully awake time in the observation group were shorter than in the control group, The difference were significant(t=3.547,4.279, P＜0.05); The incidence of postoperative adverse reactions in the control and observation groups was 3.13% and 0%, respectively, The difference was not significantly significant(χ²=1.015,P＞0.05); The OPS score scores were significantly lower at 2 h, 4 h, 8 h, and 12 h in the observed group, compared with the control group, The difference of OPS scores at 24 h and 48 h was statistical significant(P＜0.05).The difference was not significantly significant(P＞0.05). Conclusion:General anesthesia combined with sacral block or transverse abdominal muscle plane block can be used for laparoscopic surgery in children with spinal sheath fluid, for it effectively reduces hemodynamic fluctuations and has less adverse reactions in children, but the children with general anesthesia+abdominal transverse muscle plane block plan group take less time to wake up and achieve more ideal postoperative analgesic effect.

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