老年腹股沟疝患者在超声引导下髂腹下与髂腹股沟腹横肌平面阻滞的麻醉效果分析

目的探讨老年腹股沟疝患者应用超声引导下横肌平面阻滞（TAPB）联合髂腹下及髂腹股沟神经阻滞的临床效果。 方法选取2017年10月至2018年10月平罗县人民医院收治的老年腹股沟疝患者60例，采用随机数字表法将患者分为试验组和对照组，各30例，对照组行常规硬膜外麻醉，试验组行超声引导下TAPB联合髂腹下及髂腹股沟神经阻滞。比较2组手术相关临床参数、围手术期血流动力学变化，记录术后苏醒躁动及追加镇痛药情况，并进行患者躁动及疼痛的评估。 结果试验组术后苏醒时间短于对照组（P<0.05）；从手术麻醉前至手术结束，试验组患者心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO₂）水平均无变化（P>0.05），对照组患者HR、MAP水平在切皮前、切皮后10 min、手术结束时均高于手术麻醉前（P<0.05）；试验组患者在上述时间点的HR、MAP水平均低于对照组（P<0.05）；试验组苏醒躁动发生率、追加镇痛药发生率和Cravero评分均低于对照组（P<0.05）；试验组患者苏醒时，术后2、4、8 h的视觉模拟量表评分（VAS）均显著低于对照组（P<0.05）。 结论老年腹股沟疝患者应用超声引导下TAPB联合髂腹下及髂腹股沟神经阻滞可明显缩短苏醒时间，减少术后疼痛感，围手术期患者的血流动力学更稳定，且镇静效果好。

Analysis of the clinical effect of ultrasound-guided transverse muscle plane block combined with iliohypogastric nerve and ilioinguinal nerve block in elderly patients with inguinal hernia

ObjectiveTo investigate the clinical effects of ultrasound-guided transverse muscle plane block (TAPB) combined with iliohypogastric nerve and ilioinguinal nerve blocks in elderly patients with inguinal hernia. MethodsA total of 60 elderly patients with inguinal hernia treated in Pingluo County People's Hospital from October 2017 to October 2018 were selected. The patients were divided into experimental group and control group by random number table method, with 30 patients in each group. The control group received epidural anesthesia, and the experimental group underwent ultrasound-guided TAPB combined with iliohypogastric nerve and ilioinguinal nerve blocks. The clinical parameters and perioperative hemodynamic changes of the two groups were compared, and the postoperative awakening agitation and additional analgesics were recorded, and the patients' agitation and pain were evaluated. ResultsThe awakening time in the experimental group was shorter than that in the control group (P<0.05). From before anesthesia to the end of the operation, the levels of HR, MAP, and SpO₂ in the experimental group unchanged (P>0.05). The levels of HR and MAP before the incision, at 10 minutes after the incision and at the end of the surgery in the control group were higher than those before the anesthesia (P<0.05); the HR and MAP levels of the patients in the experimental group at the above time points were lower than those in the control group (P<0.05); The incidence of awakening agitation, the incidence of additional analgesics, and the Cravero score in the experimental group were all lower than those in the control group (P<0.05). The VAS scores of the experimental group were lower than those in the control group at the time of waking, 2 h, 4 h and 8 h after surgery (P<0.05). ConclusionThe use of TAPB combined with iliohypogastric nerve and ilioinguinal nerve block in elderly patients with inguinal hernia can significantly shorten the awake time and reduce postoperative pain. The hemodynamics of patients during perioperative period is more stable and the sedation effect is good.