超声引导下腹横平面联合髂腹股沟、髂腹下神经阻滞在高龄患者斜疝手术中的应用

Application of ultrasonography to joint ilioinguinal and iliohypogastric nerve block in oblique hernia operation in elderly patients

摘要:

目的通过超声引导下腹横平面（TAP）阻滞联合髂腹股沟、髂腹下神经（IIN）阻滞在高龄患者斜疝无张力补片修补术中的应用，评估这种麻醉方法的安全性及可行性。方法拟行单侧腹股沟斜疝手术的患者60 例，随机分为A 组（TAP+IIN）阻滞麻醉和B 组IIN 阻滞麻醉。观察记录两组麻醉前（T0）、手术切皮时（T1）、疝囊剥离时（T2）、缝补片时（T3）、术毕（T4）的MAP、HR 的变化；术中舒芬太尼的用量及感觉阻滞区域平面；临床麻醉效果评级及不良反应；2、4、6、8、12 和24 h的VAS 评分以及BCS 舒适度评分。结果A 组与B 组比较，T2及T3时点的HR、MAP 差异有统计学意义（P <0.05），A 组低；但T0 、T1 及T4 时点HR 及MAP A组和B 组 间比较差异无统计学意义（P >0.05）；术后2、4、6 和8 h各时点A组VAS 评分均低；BCS 舒适度评分高，差异有统计学意义（P <0.05），但12 和24 h的VAS 及BCS 评分比较，差异无统计学意义（P >0.05）；A 组感觉阻滞平面高，麻醉效果好，术中的舒芬太尼用量低，差异有统计学意义（P <0.05）；两组患者均未发生神经损伤、穿刺损伤及感染。结论TAP阻滞联合髂腹股沟、IIN阻滞用于高龄患者行腹股沟斜疝无张力补片修补术，临床麻醉效果好。术中血压循环稳定，操作简单安全且并发症少，舒适度高，是高龄患者行斜疝无张力补片修补术比较理想的麻醉方法。

Abstract:

Objective To evaluate safety and feasibility of ultrasound-guided abdominal transverse plane (TAP) block combined ilioinguinal and iliohypogastric nerves (IIN) block for oblique hernia patch repair without tension in elderly patients. Methods A group of 60 patients with unilateral inguinal hernia surgery were randomly divided into group A (TAP + IIN block anesthesia) and group B (IIN block). The changes of MAP and HR before anesthesia (T0),at the time of surgical incision (T1), dissection of hernia sac (T2) and suture of repair patch (T3) and after operation(T4), the dosage of Sufentanil and the plane of sensation block, the rating of clinical anesthetic effectiveness and adverse reactions; the VAS scores and BCS comfort score 2, 4, 6, 8, 12 and 24 h after operation were observed in the two groups. Results Compared to the group B, HR and MAP at T2 and T3 were lower in the group A, the differences were statistically significant (P < 0.05). However, there was no significant difference in HR or MAP at T0,T1, or T4 between the groups A and B (P > 0.05). Compared to the group B, the VAS scores were lower and the BCS comfort score was higher in the group A at 2, 4, 6 and 8 h after operation, the differences were statistically significant (P < 0.05); but there were no statistical differences in the VAS or BCS scores at 12 or 24 h after operation between the two groups (P > 0.05). The group A had a higher plane of sensation block, better anesthetic effect, and smaller dosage of Sufentanil compared to the group B and the differences were statistically significant (P < 0.05). There was no nerve damage, puncture injury or infection in either group. Conclusions When ultrasound-guided abdomen transverse plane block combined ilioinguinal and iliohypogastric nerve block is used for patch repair of inguinal hernia without tension, the anesthetic effect is good, intraoperative blood pressure is stable, operation is easy and safe and complications are few, and the degree of comfort is high. Therefore it is an ideal method of anesthesia for patch repair of hernia without tension in elderly patients.