目的 观察超声引导腹横肌平面(TAP)联合髂腹下神经阻滞行腹腔镜下腹股沟疝修补术的效果及并发症。方法 选取2019年8月—2021年7月收治的80例拟行腹腔镜下腹股沟疝修补术治疗的患者并纳入研究。分作联合组及单纯组,每组各40例。单纯组实施单纯超声引导TAP阻滞,联合组则实施超声引导TAP联合髂腹下神经阻滞。对比两组围手术期不同时间点的平均动脉压(MAP)、心率(HR)以及血氧饱和度(SpO2)水平,阻滞术后不同时间点的疼痛情况,并发症发生情况。结果 联合组麻醉后10 min1以及牵拉疝囊时的MAP水平分别高于对单纯组(均P<0.05),且两组不同时间段的HR及SPO2水平对比,差异均无统计学意义(均P>0.05)。联合组阻滞术后2、6、12、24、48 h时的VAS评分分别低于单纯组(均P<0.05)。联合组恶心呕吐、心率增快、血压升高发生率分别为2.50%、0.00%、0.00%,均低于单纯组的17.50%、10.00%、10.00%(均P<0.05)。结论 超声引导TAP联合髂腹下神经阻滞行腹腔镜下腹股沟疝修补术有利于维持患者血流动力学稳定,镇痛效果显著,且有效降低并发症发生率。
Objective To study the effect of laparoscopic inguinal hernia repair with ultrasound-guided transversus abdominis plane (TAP) combined with iliohypogastric nerve block and to analyze the complications. Methods From August 2019 to July 2021, a total of 80 patients who planned to undergo laparoscopic inguinal hernia repair were included in this study. The patients were divided into a combined treatment group and a control group, with 40 cases in each group. The control group received ultrasound-guided TAP block, while the combined group received ultrasound-guided TAP combined with iliohypogastric nerve block. The mean arterial pressure (MAP), heart rate (HR), and blood oxygen saturation (SpO2) levels at different time points during perioperative period were compared between the two groups, as well as the pain and complications at different time points after block. Results The MAP levels of the combined treatment group at 10 min after anesthesia and at pulling the hernia were higher than the levels of the control group (P<0.05), and there were no significant differences in HR and SpO2 levels between the two groups at different time periods (P>0.05). The VAS scores of the combined treatment group at 2 h, 6 h, 12 h, 24 h, and 48 h after block were lower than the scores of the control group (P<0.05). The incidence rates of nausea and vomiting, heart rate increase, and blood pressure increase in the combined treatment group were 2.50%, 0.00%, and 0.00%, respectively, which were all lower than those of the individual treatment group (17.50%, 10.00%, and 10.00%; P<0.05). Conclusion Laparoscopic inguinal hernia repair with ultrasonic-guided TAP combined with iliohypogastric nerve block is beneficial to maintain hemodynamic stability, has significant analgesic effects, and can effectively reduce the incidence of complications.
[1] 陈惠英,刘衬云,叶玉燕.超声引导下右美托咪定联合罗哌卡因腹横肌平面阻滞对儿童腹股沟疝修补术后镇痛效果研究[J].中国医刊,2021,56(2):219-222.
[2] 纪健,李亚春,鲁应军,等.超声引导下髂腹股沟-髂腹下神经阻滞在老年腹股沟疝手术中应用效果及安全性分析[J].解放军预防医学杂志,2019,37(10):8-9.
[3] 黄志,夏维,柯晋源,等.超声引导下髂腹股沟/髂腹下神经阻滞联合生殖股神经生殖支阻滞在老年腹股沟疝修补术中的应用效果[J].临床麻醉学杂志,2020,36(2):135-139.
[4] 吴云,金啸,叶松,等.超声引导下髂腹股沟及髂腹下神经阻滞联合腹直肌鞘阻滞在腹腔镜小儿疝高位结扎术中的应用[J].医药导报,2018,37(8):973-976.
[5] 杨振龙,吴纯东,左东,等.超声引导髂腹股沟-髂腹下神经联合阻滞与全身麻醉对腹股沟疝手术患儿生理参数的影响[J].中华疝和腹壁外科杂志(电子版),2020,14(2):138-141.
[6] 刘松华,方懿,曹理言,等.右美托咪啶联合超声引导下神经阻滞在合并基础疾病的老年患者开放性腹股沟疝手术中的应用[J].中国医师杂志,2019,21(6):810-813.
[7] 吴航,李凯,李龙云,等.髂腹下-髂腹股沟-生殖股神经生殖支联合神经阻滞在老年患者无张力疝修补术中的应用价值[J].中国老年学杂志,2018,38(13):3153-3155.
[8] 谢颖,李林佶,任普圣,等.超声引导下腰方肌阻滞与腹横肌平面阻滞在腹股沟疝无张力疝修补术中麻醉效果的比较[J].中国老年学杂志,2020,40(1):95-98.
[9] 杨新平,李嵩山,廖长剑,等.超声引导下腹横肌平面阻滞和髂腹股沟/髂腹下神经阻滞应用于腹股沟疝修补术镇痛效果比较[J].安徽医学,2016,37(7):815-818.
[10] 唐荣,刘卓,杨建平,等.老年腹股沟疝患者在超声引导下髂腹下与髂腹股沟腹横肌平面阻滞的麻醉效果分析[J].中华疝和腹壁外科杂志(电子版),2020,14(6):655-659.
[11] 范慧珍,郑玉宾.髂腹下-髂腹股沟神经阻滞与腹横平面阻滞在老年患者腹股沟疝修补术中应用比较[J].中国药物与临床,2019,19(13):2260-2262.
[12] 孙熠,王海云,华伟,等.罗哌卡因用于超声引导老年腹股沟疝患者髂腹下、髂腹股沟联合生殖股神经阻滞的EC50及EC95[J].天津医药,2020,48(7):654-656.
[13] 冯麟. 超声引导下腹横肌平面阻滞对小儿腹股沟疝修补术后早期镇痛及应激反应的影响[J].成都医学院学报,2019,14(2):198-201.
[14] 王黎,李佳蔓.术前右美托咪定滴鼻联合腹横肌平面及髂腹下-髂腹股沟神经阻滞对行全身麻醉腹股沟疝手术患者的疗效[J].中华疝和腹壁外科杂志(电子版),2020,14(4):396-399.
[15] 汪飞燕,张卫花,邵雪泉,等.腹横肌平面阻滞对老年患者腹腔镜腹股沟疝修补术后的镇痛效果[J].浙江医学,2018,40(2):2568-2570.