超声引导下幼儿骶管麻醉在小儿疝手术中的应用

目的探讨超声引导下幼儿骶管麻醉在小儿疝手术中的应用价值。 方法回顾性分析2016年1至12月，陆军特色医学中心行小儿疝手术的100例患儿的临床资料。根据麻醉方式不同，将其分为观察组（52例）与对照组（48例）。观察组患儿行超声引导下骶管麻醉，对照组患儿行阻力消失技术定位骶管穿刺，比较2组患儿的麻醉效果。 结果（1）观察组患儿穿刺时间、穿刺次数及术后苏醒时间、氯胺酮使用剂量、术毕离开手术室时间均明显低于对照组，差异均有统计学意义（P均<0.05）。（2）观察组患儿骶管阻滞成功率明显高于对照组，差异有统计学意义（P<0.05）。（3）观察组患儿术后镇痛效果明显优于对照组，差异有统计学意义（P<0.05）。（4）观察组患儿苏醒期躁动评分与术后（2、4、8 h）疼痛评分明显低于对照组，差异均有统计学意义（P均<0.05）。（5）气腹前，2组患儿心率、平均动脉压（mean artery pressure，MAP）、呼气末二氧化碳分压（end-tidal carbon dioxide partial pressure，PetCO₂）比较，差异无统计学意义（P>0.05）；气腹后，观察组心率、MAP、PetCO₂水平明显高于对照组，差异均有统计学意义（P均<0.05）。2组患儿治疗前后血压、血氧饱和度、pH值比较，差异均无统计学意义（P均>0.05）。（6）观察组不良反应发生情况明显低于对照组，差异有统计学意义（P<0.05）。 结论超声引导下幼儿骶管麻醉应用于小儿疝手术，定位准确，患儿苏醒时间短，镇痛效果好，并减少其苏醒期躁动，改善患儿血气与循环，安全有效。

Application value of ultrasound-guided caudal anesthesia in infants for pediatric hernia surgery

ObjectiveTo study on the application value of ultrasound-guided caudal anesthesia in infants for pediatric hernia surgery. Methods100 children were treated with pediatric hernia surgery in Army Characteristic Medical Center from January 2016 to December 2016. They were considered as study objects and the clinical data were analyzed retrospectively. They were divided into observation group (n=52) and control group (n=48). The patients were treated with ultrasound-guided caudal anesthesia in the observation group, while the patients were treated with positioning of sacral puncture by resistance disappearance technique in the control group. The anesthetic effect was observed and compared. Results(1) Puncture time, number of puncture, dosage of ketamine, time to leave operating room after operation and postoperative recovery time in the observation group were significantly lower than the control group (P<0.05); (2) Sacral block success rate in the observation group was significantly higher than the control group (P<0.05); (3) Postoperative analgesic effect in the observation group was significantly better than the control group (P<0.05); (4) The restlessness score and postoperative pain scores (at 2, 4 and 8 hours after operation) in the observation group were significantly lower than the control group (P<0.05); (5) Before pneumoperitoneum, there was no statistically significant difference in the comparison of HR, MAP and PetCO₂ between the two groups (P>0.05). After pneumoperitoneum, HR, MAP and PetCO₂ levels in the observation group were significantly higher than those in the control group (P<0.05). However, there was no significant difference in BP, SpO₂ and pH before and after treatment (P<0.05). (6) The incidence of adverse reactions in the observation group was significantly lower than the control group (P<0.05). ConclusionUltrasound guided caudal anesthesia applied in pediatric hernia surgery has the advantages of accurate positioning, short recovery time, and better analgesic effect. Besides, it can reduce the restlessness in awakening period and improve the blood gas and circulation. This method is safe and effective, being worthy of further clinical promotion and application.