不同鎮(zhèn)痛方法在小兒腹腔鏡手術(shù)中的應(yīng)用比較

樓其鋒 沈榮榮 楊鑫

[摘要] 目的 研究不同鎮(zhèn)痛方法在小兒腹腔鏡手術(shù)中的應(yīng)用比較。方法? 將2020年1月至2021年1月浙江省余姚市人民醫(yī)院60例需擇期行腹腔鏡疝修補(bǔ)手術(shù)患兒按照隨機(jī)數(shù)字表法分成兩組，T組行全身麻醉氣管插管+超聲引導(dǎo)腹橫肌平面阻滯術(shù)后鎮(zhèn)痛，L組行全身麻醉氣管插管+骶管阻滯術(shù)后鎮(zhèn)痛。觀察收集術(shù)后48 h內(nèi)各時(shí)點(diǎn)小兒疼痛行為量表（FLACC）評(píng)分、Ramsay鎮(zhèn)靜評(píng)分、術(shù)后首次下床時(shí)間、術(shù)后腸道排氣時(shí)間及不良反應(yīng)發(fā)生率。結(jié)果? 術(shù)后4、8、12、24、48 h兩組患兒FLACC及Ramsay評(píng)分比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）;T組患兒術(shù)后首次下床時(shí)間[（10.57±3.29）h]早于L組[（12.94±2.63）h]，且T組術(shù)后腸道排氣時(shí)間[（8.61±3.74）h]早于L組[（10.84±3.29）h]，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）;兩組患兒術(shù)后出現(xiàn)惡心嘔吐的發(fā)生率比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05），而L組腹脹（26.67%）、尿潴留（16.67%）的發(fā)生率明顯高于T組（6.67%、0），差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論? 應(yīng)用超聲引導(dǎo)下腹橫肌阻滯的腹腔鏡手術(shù)小兒，術(shù)后鎮(zhèn)痛良好，不良反應(yīng)少，利于實(shí)現(xiàn)快速康復(fù)。

[關(guān)鍵詞] 超聲引導(dǎo);腹橫肌平面阻滯;骶管阻滯;小兒;腹腔鏡手術(shù)

[中圖分類號(hào)] R726.1? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] B? ? ? ? ?; [文章編號(hào)] 1673-9701（2022）13-0141-04

[Abstract] Objective To study the comparison of different analgesic methods in laparoscopic surgery in children. Methods A total of 60 children needing elective laparoscopic hernia repair in Yuyao People′s Hospital in Zhejiang Province from January 2020 to January 2021 were divided into two groups according to the random number table method. Postoperative analgesia was used in the T group with tracheal intubation general anesthesia + ultrasound guided transversus abdominis plain block， and in the L group with tracheal intubation general anesthesia + caudal block. The FLACC （facial expression， leg movement， activity， cry and consolability） behavioral pain assessment scale scores， Ramsay sedation scores， time to get out of bed for the first time， postoperative intestinal exhaust time and the incidences of adverse reactions at each time point within 48 hours after surgery were recorded. Results No statistically significant differences were observed in the FLACC and Ramsay scores between the two groups at 4 h， 8 h， 12 h， 24 h and 48 h after surgery （P>0.05）. The time of getting out of bed for the first time after surgery in the T group （[10.57±3.29]h） was earlier than that in the L group （[12.94±2.63]h）; the postoperative intestinal exhaust time of the T group （[8.61±3.74]h） was earlier than that of the L group （[10.84±3.29]h）; the differences were statistically significant （P<0.05）. No statistically significant difference was observed in the incidence of postoperative nausea and vomiting between the two groups （P>0.05）. The incidences of abdominal distension （26.67%） and urinary retention （16.67%） in the L group were significantly higher than those （6.67%，0） in the T group， with statistically significant differences （P<0.05）. Conclusion Ultrasound guided laparoscopic transversus abdominis plane block in children has good postoperative analgesia and fewer adverse reactions， and is conducive to achieve rapid recovery.

[Key words] Ultrasound guidance; Transversus abdominis plane block （TAPB）; Caudal block; Children; Laparoscopic surgery

腹股溝斜疝常見(jiàn)于小兒，是小兒外科常見(jiàn)疾病之一，可選擇保守治療。但外科手術(shù)具有根治的效果，尤其是通過(guò)腹腔鏡輔助的微創(chuàng)手術(shù)方式因其具有創(chuàng)傷小、操作簡(jiǎn)單以及手術(shù)中可發(fā)現(xiàn)對(duì)側(cè)隱匿疝的優(yōu)勢(shì)，已被越來(lái)越多的患兒家長(zhǎng)所接受。但患兒術(shù)后疼痛與傳統(tǒng)開(kāi)放手術(shù)相比，并未明顯減輕[1]。腹橫肌平面阻滯是目前較常用于腹腔鏡術(shù)后鎮(zhèn)痛的神經(jīng)阻滯方式，且適用于小兒腹腔鏡術(shù)后鎮(zhèn)痛[2];骶管阻滯在兒科下腹部、會(huì)陰手術(shù)等手術(shù)中應(yīng)用廣泛[3]。……