超声引导下腹横肌平面阻滞联合喉罩通气全身麻醉在小儿腹股沟斜疝修补术中的应用

目的探究喉罩通气全身麻醉联合超声引导下腹横肌平面阻滞（TAPB）在小儿腹股沟斜疝手术中的应用。 方法选取2018年1至10月，成都市妇女儿童中心医院行疝囊高位结扎100例腹股沟斜疝患儿的临床资料，按随机数字表法将其分2组，每组患儿50例。对照组术中给予喉罩通气全身麻醉，观察组术中给予超声引导下TAPB联合喉罩通气全身麻醉。观察2组手术相关指标、血流动力学指标、小儿疼痛量表评分（FLACC）及不良反应发生情况。 结果观察组术后拔管时间、麻醉苏醒时间及住院时间分别为（6.27±1.86）min、（13.34±3.17）min及（2.26±0.14）d，与对照组（13.31±2.05）min、（19.86±3.48）及（3.15±1.17）d比较，差异有统计学意义（t=17.984、9.259、5.341，P均<0.001）。与T₁相比，观察组患儿T₂、T₃时段HR、SBP、DBP无显著变化，差异无统计学意义（P>0.05）；对照组HR无显著变化，差异无统计学意义（P>0.05），SBP、DBP逐渐升高，差异有统计学意义（P<0.05）。观察组T₁时段HR与对照组相比，差异无统计学意义（P>0.05），T₂、T₃时段显著低于对照组，差异有统计学意义（P<0.05）。观察组T₁时段SBP、DBP与对照组比较，差异无统计学意义（P>0.05），T₂、T₃时段显著低于对照组，差异有统计学意义（P<0.05）。观察组患儿在苏醒时、术后2 h、4 h及8 h FLACC评分分别为（2.3±0.6）分、（2.0±0.4）分、（1.6±0.5）分、（1.2±0.3）分，均低于对照组（3.0±0.5）分、（2.7±0.6）分、（2.2±0.3）分、（1.7±0.4）分，差异有统计学意义（t=40.170、47.114、57.940、49.999，P均<0.05）。观察组呕吐、咽痛、喉痉挛的发生情况分别为3（6.00%）、3（6.00%）、2（4.00%），均低于对照组10（20.00%）、11（22.00%）、9（18.00%），差异有统计学意义（χ²=4.332、5.316、5.005，P=0.037、0.021、0.025）。 结论在疝囊高位结扎术中采用超声引导下TAPB联合喉罩通气全身麻醉，能够更好地维持患儿血流动力学的稳定性，降低疼痛及不良反应的发生，值得临床推广应用。

Ultrasound-guided transverse abdominal planar block combined with laryngeal mask ventilation general anesthesia in pediatric indirect inguinal hernia surgery

ObjectiveTo explore the effect of ultrasound-guided transverse abdominal planar block (TAPB) combined with laryngeal mask ventilation general anesthesia in pediatric indirect inguinal hernia surgery. Methods100 children with indirect inguinal hernia who underwent high ligation of hernia sac in Chengdu Women's & Children's Central hospital from January 2018 to October 2018 were selected and divided into control group (n=50) and observation group (n=50) according to random number table method. The control group was given laryngeal mask ventilation general anesthesia during operation, while the observation group was given ultrasound-guided TAPB combined with laryngeal mask ventilation general anesthesia during operation. The operation related indexes, hemodynamic indexes, FLACC and adverse reactions were observed in the two groups. ResultsThe extubation time, anesthesia recovery time and hospitalization time in the observation group were significantly shorter than those in the control group (6.27±1.86) minutes vs (13.31±2.05) minutes; (13.34±3.17) minutes vs (19.86±3.48) minutes; (2.26±0.14) days vs (3.15±1.17) days, P<0.05]. Compared with T1 period, HR, SBP and DBP in T2 and T3 period of observation group had no significant difference (P>0.05), HR in control group had no significant difference (P>0.05), and SBP and DBP increased gradually (P<0.05). HR in T1 period in observation group was not significantly different from that in control group (P>0.05), but in T2 and T3 period in observation group was significantly lower than that in control group (P<0.01). There was no significant difference in SBP and DBP in T1 period between the observation group and the control group (P>0.05), but in T2 and T3 period, SBP and DBP in the observation group were significantly lower than those in the control group (P<0.01). The FLACC scores of the two groups decreased gradually at the time of awakening, 2 h, 4 h and 8 h after operation (2.3±0.6, 2.0±0.4, 1.6±0.5, 1.2±0.3, respectively), and the observation group was significantly lower than the control group (3.0±0.5, 2.7±0.6, 2.2±0.3, 1.7±0.4, P<0.05). The incidence of vomiting, sore throat and laryngeal spasm in the observation group was lower than that in the control group (6.00% vs 20.00%, 6.00% vs 22.00%, 4.00% vs 18.00%, P<0.05). ConclusionUltrasound-guided TAPB combined with laryngeal mask ventilation general anesthesia can better maintain the stability of hemodynamics and reduce the incidence of pain and adverse reactions in children with high ligation of hernia sac, which is worthy of clinical application.