摘要
目的评价超声引导下髂腹股沟／髂腹下神经阻滞在小儿腹股沟区手术中的应用效果。方法经医院伦理委员会审核通过，选取2010年7—9月间在温州医学院附属第二医院行单侧腹股沟区手术患儿100例，美国麻醉医师协会（ASA）Ⅰ级、年龄4～8岁，按随机数余数分组法分为超声组（U组）和传统组（T组），每组50例，均采用七氟烷-笑气诱导并维持、喉罩-自主呼吸的麻醉方法。U组行超声引导下神经阻滞并注入0．8％利多卡因＋0．25％左布比卡因混合液0．2ml／kg，T组按解剖定位法行神经阻滞并注入相同局麻药0．3mL／kg。记录两组患儿在各观察时点心率、呼吸频率、氧饱和度、呼气末二氧化碳及七氟烷呼气末浓度，记录术中因镇痛不足而增加七氟烷浓度的例数。采用疼痛行为评估量表对患儿苏醒时、术后2及4h行疼痛评分，评分〉3分为镇痛无效并予对乙酰氨基酚栓剂直肠给药，记录两组镇痛无效的例数。术后2及4h对患儿家长行满意度调查。结果U组患儿在切皮、牵拉疝囊时心率明显低于T组（P〈0．05），术中需提高七氟烷浓度的例数（6例）明显少于T组（17例，P〈0．05）；U组在术后恢复室、术后2及4h的疼痛评分均低于T组（P〈0．05），且镇痛无效例数（4例）明显少于T组（13例，P〈0．05）。U组患儿家长术后2h满意度高于T组（P〈0．05）。T组发生1例神经阻滞时误穿血管，两组患儿术中及术后均无其他不良反应发生。结论超声引导下小儿髂腹股沟／髂腹下神经阻滞是一种安全有效的方法，可减少局麻药用量、提高神经阻滞及术后镇痛效果。
Objective To evaluate the efficacy of ultrasound guidance for ilioinguinal or iliohypogastric nerve block in pediatric outpatients undergoing inguinal surgery. Methods The present study was approved by the ethics committee of our hospital. One hundred children with ASA status Ⅰ , aged 4- 8 years old, scheduled for unilateral inguinal surgery were randomly divided into ultrasound group （Group U） and traditional group （ Group T） （ n = 50 each）. Upon entering operation room, they were monitored by electrocardiography （ECG）, heart rate （HR） and oxygen saturation （SpO2 ）. After an induction of general anesthesia, intravenous access was established and laryngeal mask inserted with spontaneous breathing. Intraoperative anesthesia was maintained with 2% sevoflurane in 50% nitrous oxide with 50% oxygen. Children in Group U received an ilioinguinal or iliobypogastric block under ultrasonic guidance with a mixture of 0.8% lidocaine and 0.25% levobupivacaine at 0.2 ml/kg while those in Group T performed according to the traditional method of anatomical localization with the same local anesthetic at 0. 3 ml/kg. During surgery, the vital signs of HR, respiratory rate （RR）, SpO2, partial pressure of end-tidal carbon dioxide （PET CO2 ） and exhaled sevoflurane concentration were recorded. Additional intraoperative analgesic requirements were recorded. Face legs activity cry consolability （FLACC） score was used to assess the pain score postoperatively at recovery time, 2 and 4 h postoperation respectively. If the pain score was above 3, the child received acetaminophen rectally. The number of postoperative rectal acetaminophen was recorded. The degrees of parental satisfaction were investigated at 2 and 4 h postoperation. Intra-orpostoperative adverse events were also recorded. Results HR at skin incision and sac traction in Group U was significantly lower than those in Group T （P 〈0.05）. Six children （ 12% ） needed to increase inhaled sevoflurane concentration during operation in Group U versus 17 （34%） in Group T （P 〈0.05）. The pain score at recovery time, 2 and 4 h postoperation in Group U was significantly lower than those in T group （P 〈0.05 ）. Only 4 children （8%） needed postoperative rectal acetaminophen in Group U versus 13 （26%） in Group T （P 〈 0.05 ）. The degree of parental satisfaction at 2 h postoperation was significantly higher in Group U than that in Group T （ P 〈 0.05 ）. One case in Group T had needle puncturing into blood vessels. No other adverse event was observed in two groups. Conclusion The method of ultrasonic guidance for ilioinguinal or iliohypogastric nerve block is both feasible and effective. It can not only enhance the effect of nerve block, reduce the occurrences of complications, lower the quantity of local anesthetic and alleviate the medicinal toxicity.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2012年第13期873-877,共5页
National Medical Journal of China
基金
基金项目：浙江省卫生厅科研基金课题（2009A145）
关键词
超声检查
儿童
麻醉
神经阻滞
Ultrasonography
Child
Anesthesia
Nerve block
