摘要
目的探讨超声引导下甲磺酸罗哌卡因腹横肌平面阻滞(TAPB)联合异丙酚静脉麻醉在幼儿下腹部手术与术后镇痛中的临床应用效果。方法收集2015年7月至2016年4月在河北省第七人民医院综合外科及泌尿外科施行下腹部手术的患儿120例,年龄2~5岁,BMI15~18kg/m^2,ASA分级Ⅰ级。采用随机分层数字表法分为TAPB/Pro组、Pro/RF组与Sev/RF组,每组40例。TAPB/Pro组予以超声引导下TAPB联合异丙酚静脉麻醉,Pro/RF组予异丙酚+瑞芬太尼全凭静脉麻醉,Sev/RF组行七氟醚+瑞芬太尼静脉与吸入复合麻醉。所有患儿均在术后给予芬太尼静脉自控镇痛。比较各组入手术室时、手术切皮时、牵拉病灶时及苏醒时患儿的SBP、DBP、HR、MAP和SpO2;统计TAPB/Pro、Pro/RF组患儿异丙酚总量,TAPB/Pro、Pro/RF、Sev/RF组的芬太尼总量;记录患儿苏醒时间、PACU留观时间,记录术后2、4、8、12h时东安大略儿童医院疼痛评分(CHEOPS),比较术后镇痛泵按压次数。结果最终受试者110例。TAPB/Pro组各时点SBP、DBP、HR、MAP均低于Pro/RF、Sev/RF组(P<0.05),TAPB/Pro组异丙酚用量低于Pro/RF组,TAPB/Pro组芬太尼用量、苏醒时间、PACU留观时间均低于Pro/RF、Sev/RF组(P<0.05)。TAPB/Pro组术后2、4、8h时CHEOPS评分均低于Pro/RF、Sev/RF组(P<0.05),镇痛泵按压次数低于Pro/RF、Sev/RF组(P<0.05)。Pro/RF组和Sev/RF组各时点观察的各项指标之间差异无统计学意义(P>0.05)。结论在超声引导下以0.316%甲磺酸罗哌卡因行TAPB联合异丙酚静脉镇静麻醉在幼儿下腹部手术中效果确切,术中、术后镇痛效果良好。
Objective To investigate the clinical application of ultrasound-guided transversus abdominis plane block (TAPB) combined with intravenous propofol in children with lower abdominal surgery and postoperative analgesia. Methods One hundred and twenty children underwent lower abdominal surgery in the Department of General Surgery and Urology departments of the Seventh People's Hospital of Hebei Province from July 2015 to April 2016, aged 2-5 years old, body mass index of 15-18 kg/m^2 and ASA I, were randomly divided into TAPB/Pro group, Pro/RF group, and Sev/RF group, with 40 cases in each group. The patients were given ultrasound-guided TAPB combined with intravenous propofol anesthesia in TAPB/Pro group, intravenous propofol and remifentanil for total intravenous anesthesia in Pro/RF group, and compound intravenous and inhalational anesthesia with sevoflurane and remifentanil in Sev/RF group. All patients were given patient-controlled intravenous analgesia with fentanyl after the surgery. SBP, DBP, HR, MAP and SpO2 were compared among the three groups at the time of entering the operating room, skin incision, traction and awakening. The total dosage of propofol and fentanyl were counted in TAPB/Pro and Pro/RF groups. The awakening time and stay time in PACU were recorded. Children's Hospital of East Ontario Pain Score (CHEOPS) was recorded at 2, 4, 8 and 12 h after the operation and the pressing times of analgesia pump was compared after the operation. Results The final subjects was 110 cases. The levels of SBP, DBP, HR and MAP in TAPB/Pro group were lower than those in Pro/RF and Sev/RF groups (P<0.05). The dosage of propofol, the awakening time and stay time were lower than those in Pro/RF and Sev/RF groups. The CHEOPS and the pressing times of analgesia pump were lower in TAPB/Pro group at 2, 4, and 8 h after the operation than those in Pro/RF and Sev/RF groups (P<0.05). There was no significant difference for indexes mentioned above between the Pro/RF and Sev/RF groups at each time point. Conclusion The analgesic effect of ultrasound-guided transversus abdominis plane block with 0.316% methanesulfonic acid ropivacaine and intravenous propofol anaesthesia is good for lower abdominal surgery in children.
作者
唐楠
杜平均
夏丰娜
国凤慧
徐红萌
Tang Nan;Du Pingjun;Xia Fengna;Guo Fenghui;Xu Hongmeng(Department of Anesthesiology, the Seventh People's Hospital of Hebei Province, Dingzhou City 073000, China;Department of Anesthesiology, the Fourth Hospital of Hebei Medical University, Shijiazhuang City 050011, China)
出处
《实用疼痛学杂志》
2019年第3期219-225,共7页
Pain Clinic Journal
关键词
麻醉
腹肌
神经传导阻滞
儿童
超声检查
酰胺类
剂量效应关系
药物
Anesthesia
Abdominal muscle
Nerve block
Child
Ultrasonography
Amide
Dose-response relationship, drug
