罗哌卡因腹横肌平面阻滞对腹股沟疝患儿术中应激反应及术后苏醒期质量的影响

目的探究罗派卡因腹横肌平面阻滞对腹股沟疝患儿术中应激反应及术后苏醒期质量的影响。方法选取2018年1月至2019年6月,海南省妇女儿童医学中心收治的腹股沟疝患儿94例,按照随机数表法分为2组,每组患儿47例。所有患儿均行腹腔镜腹股沟疝疝囊高位结扎术,对照组给予常规全身麻醉,观察组在对照组的基础上复合罗派卡因腹横肌平面阻滞,术后持续疼痛患儿使用曲马多镇痛。比较不同时间点2组患儿的应激反应指标、术后苏醒期质量、疼痛情况及术后曲马多镇痛使用率。结果麻醉前5 min,2组患儿的E、NE和Cor水平比较,差异无统计学意义(P>0.05)。麻醉后10 min至术后即刻,2组患儿的E、NE和Cor水平均较麻醉前5 min有明显升高,且观察组的E、NE和Cor水平低于对照组,差异均有统计学意义(P<0.05)。术后8 h,观察组的E、NE和Cor水平与麻醉前5 min比较,差异无统计学意义(P>0.05);对照组E、NE和Cor水平均高于麻醉前5 min,且观察组的E、NE和Cor水平低于对照组,差异均有统计学意义(P<0.05)。观察组患儿的苏醒时间、清醒时间和PAED评分与对照组比较,差异有统计学意义(P<0.05)。观察组患儿在术后30、60和120 min时的FLACC评分与对照组比较,差异有统计学意义(P<0.05)。观察组患儿的丙泊酚使用量与对照组比较,差异无统计学意义(P>0.05);观察组的舒芬太尼使用量和曲马多使用率与对照组比较,差异有统计学意义(P<0.05)。结论对腹股沟疝患儿采用罗哌卡因腹横肌平面阻滞,能有效降低患儿术中应激反应,提高患儿术后苏醒期质量,减少术后镇痛药物使用率。

Effect of ropivacaine transversus abdominis plane block on intraoperative stress response and postoperative recovery quality of children with inguinal hernia

Objective To explore the effect of ropivacaine transversus abdominis plane block on intraoperative stress response and postoperative recovery quality of children with inguinal hernia.Methods 94 children with inguinal hernia who were admitted to the Hainan Women and Children Medical Center between January 2018 and June 2019 were selected and divided into the observation group(n=47)and the control group(n=47)by the random number table method.All subjects were treated with laparoscopic inguinal hernia sac high ligation.The control group were given routine general anesthesia.On this basis,the observation group were additionally given ropivacaine transversus abdominis plane block.Children with persistent pain after surgery were given tramadol-induced analgesia.The stress response indicators,postoperative recovery quality,situation of pain and usage of postoperative tramadol-induced analgesia were compared between the two groups at different time points.Results The levels of epinephrine(E),norepinephrine(NE)and cortisol(Cor)in the two groups from 10 minutes after anesthesia to the end of surgery were significantly higher than those at 5 minutes before anesthesia(P<0.05).Meanwhile,the levels of above indexes were lower in the observation group than the control group(P<0.05).Differences in E,NE and Cor in the observation group at 8 hours after operation and 5 minutes before anesthesia were not statistically significant(P>0.05).However,E,NE and Cor in the control group at 8 hours after operation were higher than those at 5 minutes before anesthesia(P<0.05).The levels in the observation group were lower than those in the control group at 8 hours after surgery(P<0.05).The awakening time,awake time and PAED scores of the observation group were shorter/lower than those in the control group(P<0.05),and OAA/S scores were higher than those of the control group(P<0.05).FLACC scores of the observation group at 30 minutes,60 minutes and 120 minutes after surgery were lower than those of the control group(P<0.05).There was no significant difference in the usage of propofol between the two groups(P>0.05).The usage amount of sufentanil and usage rate of tramadol in the observation group were lower than those in the control group(P<0.05).Conclusion The use of ropivacaine transversus abdominis plane block in children with inguinal hernia can effectively reduce their intraoperative stress response,improve their postoperative recovery quality,and reduce the postoperative usage rate of analgesics.