联合神经阻滞应用于老年患者腹股沟疝修补术的镇痛效果
| 作者: |
1,2周达磊,
2顾仕贤,
2毛菇,
2陶莹,
2谷永付,
2许元晶,
3周媛
1 南通大学，江苏 南通 226000 2 南通大学附属南京江北医院麻醉科，南京 210000 3 南通大学附属医院麻醉科，江苏 南通 226000 |
| 通讯: |
周媛
Email: nina_shine@126.com |
| DOI: | 10.3978/j.issn.2095-6959.2021.06.016 |
摘要
目的：评估不同联合神经阻滞方式应用于老年患者腹股沟疝修补术的镇痛效果和安全性。方法：纳入2020年3月至12月在南通大学附属南京江北医院行腹腔镜下腹股沟疝修补术的老年患者90例，采用随机数字法将患者随机分为A组、B组、C组。A组患者给予全麻复合超声引导下TAPB(transversus abdominis plane block，TAPB)联合RSB(rectus sheath block，RSB)，B组患者给予全麻复合超声引导下TAPB联合髂腹股沟神经-髂腹下神经阻滞(iliac inguinal nerves-iliac hypogastric nerves block，IINB)，C组患者仅给予全身麻醉。分析和比较3组患者围手术期不同时间点的VAS评分、心率、收缩压和舒张压，分析和比较3组患者术中麻醉药物的使用量。结果：术后48 h内，A组和B组患者的疼痛视觉模拟评分法(Visual Analogue Scale，VAS)评分无明显波动。而C组患者VAS评分增加幅度较大，差异有统计学意义(P<0.05)。术后1 h和术后6 h，C组患者VAS评分明显高于A组、B组，差异均有统计学意义(均P<0.05)。术中，A组和B组患者瑞芬太尼和丙泊酚的使用量均低于C组患者，差异均有统计学意义(均P<0.05)。围手术期，3组患者的心率和血压变化的差异均无统计学意义(P>0.05)。结论：老年患者腹股沟疝修补术中，全麻复合超声引导下TAPB联合RSB和全麻复合超声引导下TAPB联合IINB的镇痛效果显明显优于单纯全身麻醉，前两者能够减少术中麻醉药物的用量，对循环指标影响较小，具有很高的安全性。
关键词：
TAPB；RSB；髂腹股沟神经-髂腹下神经阻滞；腹股沟疝修补术；镇痛；老年患者
Analgesic effect of combined nerve block in inguinal hernia repair in elderly patients
CorrespondingAuthor: ZHOU Yuan Email: nina_shine@126.com
DOI: 10.3978/j.issn.2095-6959.2021.06.016
Abstract
Objective: To evaluate the analgesic effect and safety of different combined nerve block methods in elderly patients receiving inguinal hernia repair. Methods: A total of 90 elderly patients with inguinal hernia, who underwent laparoscopic inguinal hernia repair at our hospital from March to December 2020 were randomly divided into group A, group B, and group C by random number method. Patients in group A were given general anesthesia combined with ultrasound-guided transversus abdominis plane block (TAPB) and rectus sheath block (RSB), and patients in group B were given general anesthesia combined with ultrasound-guided TAPB and ilioinguinal nerve iliac hypogastric nerve block (IINB), while patients in group C was given general anesthesia alone. The VAS score, heart rate, systolic blood pressure and diastolic blood pressure at different time points during the perioperative period were analyzed and compared among the 3 groups. Results: Within 48 hours after the operation, no significant variation of VAS scores was observed in group A and group B. The VAS score of group C was significantly increased (P<0.05). Moreover, the VAS scores of patients in group C were significantly higher than those in group A and group B at 1 hour and 6 hours after the operation, and the differences were statistically significant (P<0.05). During the operation, the use dose of remifentanil and propofol in group A and group B were lower than those in group C, and the differences were statistically significant (P<0.05). And there was no significant difference in heart rate and blood pressure among the 3 groups at different time points during the perioperative period (P>0.05). Conclusion: General anesthesia combined with ultrasound-guided TAPB and RSB, and general anesthesia combined with ultrasound-guided TAPB and IINB both had better analgesic effect than simple general anesthesia in elderly patients receiving inguinal hernia repair, which can reduce the amount of anesthetic drugs during operation with little influence on cycle index and high safety.
Keywords：
transverse abdominis plane block; rectus abdominis sheath block; iliac inguinal nerves-iliac hypogastric nerves block; inguinal hernia repair; analgesia; elderly patients