超声引导下神经阻滞在脊柱畸形患者腹股沟斜疝手术中的应用

目的 观察超声引导下髂腹股沟-髂腹下神经阻滞用于脊柱畸形患者腹股沟斜疝手术的安全性及有效性.方法 选取择期行腹股沟斜疝手术的脊柱畸形患者30例,年龄45～73岁,ASA分级Ⅰ～ Ⅱ级,随机分为超声引导下髂腹股沟-髂腹下神经阻滞组(A组)和髂腹股沟-髂腹下神经阻滞组(B组),每组15例.术中均静脉滴注咪达唑仑0.02 mg/kg及泵注右美托咪定0.3 ug/(kg·h)辅助镇静.监测并记录麻醉前(T0)、麻醉后20 min时(T1)、切皮时(T2)、手术30 min时(T3)及术毕(T4)的MAP、SpO2、HR、镇痛评分(VAS评分)以及并发症发生率、阻滞失败后改变麻醉方式的例数.结果 A组患者术中MAP、SpO2各时间点变化比较差异无统计学意义(P＞ 0.05);HR术中减慢(P＜0.05),但在安全范围;而B组患者MAP在T2、T3、T4时间点明显高于T0和T1(P＜0.05),HR在T2时间点明显高于T0和T1(P＜0.05);A组患者HR、MAP在T2、L及T4时间点均低于B组(P＜0.05);A组患者VAS评分在T1、T2时间点低于B组(P＜0.05);B组患者因神经阻滞效果不佳改变麻醉方式例数较A组明显增多(P＜0.05).结论 与髂腹股沟-髂腹下神经阻滞相比,超声引导下髂腹股沟-髂腹下神经阻滞麻醉用于脊柱畸形患者腹股沟斜疝手术可缩短麻醉起效时间,提高麻醉成功率,不增加不良反应.

The application of ultrasound guided nerve block in inguinal hernia surgery for patients with spinal deformity

Objective To investigate the safety and efficacy of ultrasonic guided nerve block for spinal deformity patients on inguinal hernia surgery.Methods 30 cases of spinal deformity who needed inguinal hernia surgery were recruited in this study,aged 45 to 73 years old,ASA grade Ⅰ or Ⅱ.Patients were randomly divided into group A (ultrasound guided ilioinguinal/iliohypogastric nerve block) and group B (ilioinguinal/iliohypogastric nerve block),15 cases in each group,used intravenous drip of midazolam at 0.02 mg/kg then pumped dexmedetomidine at 0.3μg/(kg·h) for 20 min to auxiliary calm.The hemodynamics parameters,VAS scores at T0,T1,T2,T3,T4,and the complications such as hematoma,were recorded.Results MAP,SpO2 changes in group A at each time point had no statistical significance (P＞0.05),HR slowed down (P＜0.05),but in a safe range;MAP at T2,T3,T4 were higher than those at T0 and T1,while HR at T2 was higher than those at T0 and T1 in group B (P＜0.05);HR and MAP at T2,T3,T4 in group A were significantly lower than those in group B (P＜0.05);VAS score at T1 and T2 in group A were lower than those in group B (P＜0.05).The cases who changed the anesthesia methods in group B were more than those in group A (P＜0.05).Conclusion Compared with ilioinguinal/iliohypogastric nerve block,ultrasound guided ilioinguinal/iliohypogastric nerve block in spinal deformity patients undergoing inguinal hernia surgery could shorten the block beginning time and improve the anesthesia success rate with no more adverse effects.