超声引导下IINB联合TAPB在老年腹股沟疝修补术中的临床应用

doi:10.3760/cma.j.issn.1007-1245.2023.02.026

摘要/Abstract

摘要：

目的　探讨超声引导下髂腹下-髂腹股沟神经阻滞（IINB）联合腹横肌平面阻滞（TAPB）在老年腹股沟疝修补术中的临床价值。方法　选择2019年6月至2022年3月在英德市人民医院行择期单侧腹股沟斜疝无张力修补术的老年患者70例进行随机对照试验，其中男63例，女7例，年龄（77.61±9.85）岁。随机数字表法分为观察组和对照组，各35例。观察组采用超声引导下IINB联合TAPB进行麻醉，对照组采用传统腰硬联合阻滞麻醉。比较两组患者术毕即刻与术后6 h、12 h、24 h的视觉模拟量表（VAS）评分，观察并比较两组入室时（T0）、麻醉完成5 min（T1）、切皮后（T2）、术后6 h（T3）、术后12 h（T4）5个时点的心率（HR）和平均动脉压（MAP），并比较两组患者的麻醉效果、麻醉满意度和安全性。采用独立样本t检验、χ²检验、Fisher确切概率法进行组间比较。结果　观察组在术后6 h、12 h、24 h的VAS评分均显著低于对照组［（1.15±0.12）分比（2.26±0.21）分，（1.56±0.14）分比（4.26±0.42）分，（2.01±0.19）分比（4.47±0.41）分，均P<0.05］，观察组与对照组在T1、T2两个时间点的MAP［（83.26±8.11）mmHg（1 mmHg=0.133 kPa）比（62.06±6.39）mmHg，（84.22±8.31）mmHg比（60.29±6.03）mmHg］和HR［（68.92±6.32）次/min比（81.26±8.33）次/min，（65.29±6.26）次/min比（78.64±7.62）次/min］比较，差异均有统计学意义（均P<0.05），其余时间点比较，差异均无统计学意义（均P>0.05）。观察组麻醉总有效率为88.57%（31/35），对照组为85.71%（30/35），差异无统计学意义（P>0.05）。观察组患者麻醉满意度得分为（2.96±0.26）分，明显高于对照组的（2.18±0.22）分（P<0.05）。观察组患者术后均未出现尿潴留、恶心呕吐和心动过缓等不良反应，对照组出现尿潴留4例，发生率为11.43%，对照组不良反应发生率高于观察组（P<0.05）。结论　超声引导下IINB联合TAPB用于老年腹股沟疝修补术术中血流动力学更稳定，术后镇痛效果好且安全性高，值得临床推广。

关键词:

老年患者, 腹股沟疝修补术, 超声引导, 髂腹下-髂腹股沟神经阻滞, 腹横肌平面阻滞

Abstract:

Objective　To investigate the clinical value of ultrasonic-guided ilio-subventral and ilio-inguinal nerve block (IINB) and transverse abdominal muscle block (TAPB) in inguinal hernia repair for elderly patients. Methods　A total of 70 elderly patients who underwent selective tension-free unilateral inguinal hernia repair in Yingde People's Hospital from June 2019 to March 2022 were selected for the random control trial, including 63 males and 7 females who were (77.61±9.85) years old. They were divided into an observation group and a control group by the random number table method, with 35 cases in each group. The observation group took ultrasonic-guided IINB and TAPB. The control group took traditional lumboepidural block anesthesia. There was no difference in general data between the two groups. The scores of Visual Analogue Scale (VAS) immediately and 6, 12, and 24 h after operation were compared between the two groups. The heart rates (HR) and mean arterial pressures (MAP) at entry (T0), 5 min after anesthesia (T1), after incision (T2), and 6 (T3) and 12 h (T4) after surgery were compared between the two groups. The anesthesia effects, anesthesia satisfactions, and incidences of adverse events were compared between the two groups. The independent-sample t test, χ² test, and Fisher's exact test were used for the comparison between the 2 groups. Results　The VAS scores 6, 12, and 24 h after surgery in the observation group were significantly lower than those in the control group [(1.15±0.12) vs. (2.26±0.21), (1.56±0.14) vs. (4.26±0.42), and (2.01±0.19) vs. (4.47±0.41); all P<0.05]. There were statistical differences in MAP's [(83.26±8.11) mmHg (1 mmHg=0.133 kPa) vs. (62.06±6.39) mmHg and (84.22±8.31) mmHg vs. (60.29±6.03) mmHg] and HR's [(68.92±6.32) min^-1 vs. (81.26±8.33) min^-1 and (65.29±6.26) min^-1 vs. (78.64±7.62) min^-1] at T1 and T2 between the observation group and the control group, with statistical differences (all P<0.05); there were no statistical differences in MAP's and HR's at other time points between these two groups (all P>0.05). The total effective rate of anesthesia in the observation group was 88.57% (31/35), and was 85.71% (30/35) in the control group, with no statistical difference (P>0.05). The anesthesia satisfaction score of the observation group was significantly higher than that of the control group [(2.96±0.26) vs. (2.18±0.22); P<0.05]. There were no postoperative adverse events, such as urinary retention, nausea and vomiting, and bradycardia, in the observation group, while there were 4 cases of urinary retention in the control group, with an incidence of 11.43%; the incidence of adverse reactions in the control group was significantly higher than that in the observation group (P<0.05). Conclusion　IINB and TAPB in inguinal hernia repair for elderly patients can make the perioperative hemodynamics more stable, with postoperative analgesia effect and high safety, so it is worthy of clinical application.

Key words:

Elderly patients, Inguinal hernia repair, Ultrasonic guided, Ilio-subventral and ilio-inguinal nerve block, Transverse abdominis plane block

谭军源张荣李银妹.

超声引导下IINB联合TAPB在老年腹股沟疝修补术中的临床应用 [J]. 国际医药卫生导报, 2023, 29(2): 255-.

Tan Junyuan, Zhang Rong, Li Yinmei.

Clinical application of ultrasound-guided IINB combined with TAPB in inguinal hernia repair for elderly patients [J]. International Medicine and Health Guidance News, 2023, 29(2): 255-.

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