改良竖脊肌平面阻滞联合右美托咪定在腹股沟疝修补中的应用

目的探讨改良竖脊肌平面阻滞联合右美托咪定在腹股沟疝修补术中术后的应用。方法选取2017年3月至2019年3月,遵义医科大学第五附属珠海医院行腹腔镜双侧腹股沟疝修补术患者90例,按照麻醉方式不同分为2组,每组患者45例。对照组术前采用腹部切口右美托咪定局部浸润麻醉,试验组术前应用改良竖脊肌平面阻滞联合右美托咪定麻醉。对比2组患者手术耗时、术中不同阶段的心血管指标(平均动脉压、心率、血氧饱和度)、镇静效果(Ramsay评分)、不良反应(战栗、躁动、神经损伤)发生率、术后各时段镇痛效果(VAS评分)和患者清醒后对手术麻醉满意度。结果在T2、T3、T4时,试验组患者的MAP和HR显著低于对照组,差异有统计学意义(P<0.05);术中试验组患者T1~T4阶段的VAS评分均显著低于对照组(P<0.05),Ramsay评分均显著高于对照组(P均<0.05);对照组患者的不良反应发生率显著高于试验组(15.56%比2.2%,P<0.05);对照组出院后总满意度显著低于试验组(71.11%比93.33%,P<0.05)。结论改良竖脊肌平面阻滞联合右美托咪定在腹腔镜腹股沟疝修补术中可以降低患者的焦虑程度,减轻患者痛觉,减少术后不良反应发生率,相对传统方法患者更为满意。

Application of modified erector spinal muscle plane block combined with dexmedetomidine in Inguinal hernia repair

Objective To evaluate the application of dexmedetomidine followed by modified erector spinal muscle plane block in inguinal hernia repair.Methods From March 2017 to March 2019,90 patients with inguinal hernia who underwent laparoscopic inguinal herniorhaphy in our hospital were selected and randomly divided into the control group and the experimental group,45 cases in each group.The control groupreceived local infiltration anesthesia and 40 patients in the experimental group applied modified erector spinal muscle plane block.The operating time,the signs of Circulatory system(mean arterial pressure,heart rate,blood oxygen saturation),analgesic effect(VAS score),sedation effect(Ramsay score),and adverse reactions(chills,restlessness)of patients with anesthesia were compared between the two groups,Nerve injury,etc.),the analgesic effect(VAS score)at each postoperative period and the patient's satisfaction with surgical anesthesia after being awake.Results The MAP and HR of the control group of T2 and T4 were significantly higher than the T0 and there was statistically significant difference(P<0.05);Intraoperative T1-T4 experimental group patients'VAS scores were significantly lower than those of the control group(all P<0.05),Ramsay scores were significantly higher than those of the control group(all P<0.05);the incidence of adverse reactions in the control group Significantly higher than the experimental group(P<0.05);at 1,4,and 12 hours after surgery,the pain of the experimental group was significantly lower than that of the control group with statistical difference(P<0.05);The patients in the experimental group were more satisfied with the operation than the control group(P<0.05).Conclusion Modified erector spinal muscle plane block combined with dexmedetomidine can reduce the anxiety of the patients and relieve the pain of in laparoscopic inguinal herniorhaphy and reduce the incidence of postoperative adverse reactions.Patients are more inclined this method than past methods.