超声引导腹横肌平面阻滞对小儿腹腔镜手术术后躁动的影响

目的 观察超声引导腹横肌平面（transversus abdominis plan，TAP）阻滞对腹腔镜手术患儿术后躁动的影响。方法 择期拟行腹腔镜疝囊高位结扎术患儿180例。ASAⅠ~Ⅱ级，按年龄分为：1~3岁组，4~6岁组，7~12岁组，每组60例。各年龄组再随机分为三组，T组：全麻+TAP组；P组：全麻+PCIA（静脉自控镇痛）组；A组：单纯全麻组。记录拔管后30分钟内小儿麻醉苏PAED（pediatric anesthesia emergence delirium，PAED）评分。记录拔管后、术后2小时、4小时、8小时和12小时FLACC疼痛评分。记录术中各组患儿在切皮前、切皮后2分钟、切皮后10分钟、手术结束，各时间点的平均动脉压、心率。比较三组患儿术后拔管时间、苏醒时间及PACU停留时间。记录三组患儿术后24小时镇静、镇痛药物使用情况，P组患儿术后镇痛泵按压次数。术后并发症发生情况，如恶心呕吐、切口感染、尿潴留、呼吸抑制等。结果 三组患者在切皮前、切皮后2分钟、切皮后10分钟、手术结束，各时间点的平均动脉压、心率差异均无统计学意义。患儿拔管后30分钟内PAED评分T组低于P组、A组（P<0.05）。T组中、低年龄段患儿拔管后、术后2小时FLACC低于A组、P组（P<0.05）。三组患儿拔管时间无统计学差异，T组中、高年龄段患儿清醒时间较A组短，低年龄段患儿PACU停留时间较A组短，差异有统计学意义（P<0.05）。术后镇静、镇痛药物次数T组较A组少，差异有统计学意义（P<0.05）。手术后24小时内，P组患儿有2例发生恶心呕吐，3例发生嗜睡，2例发生尿潴留，A组1例发生恶心呕吐，T组未发生，三组不良反应发生率无统计学差异。结论 超声引导TAP阻滞可有效降低小儿腹腔镜手术术后躁动发生率，减轻术后疼痛程度，减少术后镇静、镇痛药物的使用。

Preventive effect of ultrasound guided transversus abdominis plane block on emergence agitation after laparoscopic surgery in children

Objective To investigate the preventive effect of ultrasound guided transversus abdomin is plane (TAP) block on emergence agitation after laparoscopic surgery in children.Methods Totally, 180 children scheduled for elective inguinal ligation of hernia sac were divided into three groups:group 1-3 years of age, group 4-6 years of age and group 7-12 years of age, 60 children in each group. The pediatric patients in each age group were further randomly divided into three groups:group T (TAP block combined with general anesthesia),group P (PCIA after general anesthesia) and group A (simple general anesthesia). The pediatric anesthesia emergence delirium (PAED)scale within 30 minutes of extubation,the Face Leg Activity Cry Consolability (FLACC) score after extubation and postoperative 2,4, 8 and 12 h, and the mean arterial pressure and heart rate at different time were recorded. The extubation time, recovery time, length of stay in post-anesthesia care unit (PACU),postoperative medication, and postoperative adverse reactions were compared among the three groups.Results There were no significant differences in the mean arterial pressure and heart rate among the three groups at different time.The PAED scale within 30 minutes of extubation in group T was lower than in group P and group A(P<0.05).The FLACC scores of middle and low age children in group T after extubation and postoperative 2 h were lower than those in group A and P (P<0.05).There was no significant difference in extubation time among the three groups. The recovery time of children in the middle and high age groups in group T was shorter than that in group A, and the PACU stay time of children in the low age groups in group T was shorter than that in group A (P<0.05). The use of analgesics and sedatives in group T was less than groups A(P<0.05). Two children had nausea and vomiting in group P, three children had sleepiness and two children had urinary retention within 24 hours after surgery. There was only one child with nausea and vomiting in group A.There was no significant difference in the incidence of adverse reactions among the three groups. Conclusion TAP block guided by ultrasound in pediatric laparoscopic surgery can effectively reduce the incidence of postoperative emergence agitation. It provides good postoperative analgesia and reduces the use of analgesics and sedatives.