腹直肌阻滞麻醉与腰硬联合麻醉在斜疝手术中的疗效比较
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摘要
目的比较腹直肌阻滞麻醉与腰硬联合麻醉在成人腹股沟斜疝手术中的临床疗效。方法以我院2017年2～12月收治的拟行腹股沟斜疝成人患者80例为研究对象,并随机分为腹直肌阻滞麻醉组(观察组)与腰硬联合麻醉组(对照组),各40例。比较两组麻醉效果,两组患者在麻醉后5 min、10 min,切皮后5 min,手术结束前,术后2 h围术期平均动脉压、心率的变化及患者围术期血流动力学变化、术后并发症等情况。结果两组麻醉效果比较,观察组麻醉优良率为90.0%,对照组麻醉优良率为87.5%,两组比较差异无统计学意义(P>0.05)。两组患者围术期平均动脉压、心率组间比较,差异无统计学意义(P>0.05),观察组麻醉后10 min患者平均动脉压为(91.1±13.2)mm Hg,心率为(92.2±8.3)次/min,对照组麻醉后10 min患者平均动脉压为(73.4±16.6)mmHg,心率(76.3±14.2)次/min,两组比较差异有统计学意义(P<0.05)。观察组麻醉并发症发生率为2.5%,对照组麻醉并发症发生率为30.0%,两组比较差异统计学意义(P<0.05)。结论超声引导下腹直肌阻滞在成人腹股沟斜疝手术麻醉中效果确切,围术期血流动力学稳定,术后并发症少。
Objective To compare the clinical efficacy of abdominal rectus block anesthesia and combined spinal and epidural anesthesia in adult inguinal hernia surgery. Methods 80 cases of adult patients with inguinal hernia who were admitted to our hospital from February to December in 2017 were randomLy divided into the abdominal rectus block anesthesia group(observation group) and the combined spinal and epidural anesthesia group(control group), 40 cases in each group. The anesthetic effects of the two groups were observed and compared. The perioperative mean arterial pressure, heart rate changes, and perioperative hemodynamic changes were observed at 5 minutes after anesthesia, 10 minutes after anesthesia, 5 minutes after skin incision, end of the operation, and 2 hours after surgery were compared.The complications were also observed. Results In terms of anesthetic effect, the excellent and good rate of anesthesia was 90.0% in the observation group and 87.5% in the control group. There was no significant difference between the two groups(P>0.05). There was no significant difference in the mean arterial pressure and heart rate between the two groups(P>0.05). The average arterial pressure was(91.1±13.2)mmHg and the heart rate was(92.2±8.3)bpm in the observation group 10 minutes after anesthesia. The mean arterial pressure of the control group was(73.4±16.6)mmHg and the heart rate was(76.3±14.2) bpm 10 minutes after anesthesia. The difference between the two groups was statistically significant(P<0.05). The incidence of postoperative complications was 2.5% in the observation group and 30.0% in the control group. The difference between the two groups was statistically significant(P<0.05). Conclusion Ultrasound-guided rectus abdominis blockade is effective in anesthesia for adult inguinal hernia. Perioperative hemodynamics are stable and postoperative complications are few.
Objective To compare the clinical efficacy of abdominal rectus block anesthesia and combined spinal and epidural anesthesia in adult inguinal hernia surgery. Methods 80 cases of adult patients with inguinal hernia who were admitted to our hospital from February to December in 2017 were randomLy divided into the abdominal rectus block anesthesia group(observation group) and the combined spinal and epidural anesthesia group(control group), 40 cases in each group. The anesthetic effects of the two groups were observed and compared. The perioperative mean arterial pressure, heart rate changes, and perioperative hemodynamic changes were observed at 5 minutes after anesthesia, 10 minutes after anesthesia, 5 minutes after skin incision, end of the operation, and 2 hours after surgery were compared.The complications were also observed. Results In terms of anesthetic effect, the excellent and good rate of anesthesia was 90.0% in the observation group and 87.5% in the control group. There was no significant difference between the two groups(P>0.05). There was no significant difference in the mean arterial pressure and heart rate between the two groups(P>0.05). The average arterial pressure was(91.1±13.2)mmHg and the heart rate was(92.2±8.3)bpm in the observation group 10 minutes after anesthesia. The mean arterial pressure of the control group was(73.4±16.6)mmHg and the heart rate was(76.3±14.2) bpm 10 minutes after anesthesia. The difference between the two groups was statistically significant(P<0.05). The incidence of postoperative complications was 2.5% in the observation group and 30.0% in the control group. The difference between the two groups was statistically significant(P<0.05). Conclusion Ultrasound-guided rectus abdominis blockade is effective in anesthesia for adult inguinal hernia. Perioperative hemodynamics are stable and postoperative complications are few.
引文
[1]王东坡.无张力疝修补术应用于腹部沟嵌顿性斜疝治疗的临床分析[J].中西医结合心血管病电子杂志,2018,6(34):45
[2]张维娥,邵雪梅.腰-硬联合麻醉在高龄患者半髋关节置换术中的应用[J].临床麻醉学杂志,2011,27(2):203.
[3]赵发民,敬广霞,刘洋洋.超声引导定位与传统解剖定位行臂丛神经阻滞的临床麻醉效果分析[J].临床研究,2018,26(12):118-120.
[4]Mcdonnell JG,Curley G,Carney J,et al.The analgesic efficacy of transversus abdominis plane block after cesarean delivery:A randomized controlled trial[J].Anesth Analg,2008,106(1):186-191.
[5]赵发民,敬广霞,刘洋洋.超声引导定位与传统解剖定位行臂丛神经阻滞的临床麻醉效果分析[J].临床研究,2018,26(12):118-120.
[6]董彦,张庆,黄帆,等.超声引导下不同浓度罗哌卡因腹横肌平面阻滞用于剖宫产术后镇痛的效果[J].临床麻醉学杂志,2015,12(10):20254-21416.
[7]孟庆云,柳顺锁,刘志双.神经阻滞学[M].北京:人民卫生出版社,2013:213-214.
[8]罗中兵,张燕辉,宋晓阳,等.联合腰麻硬膜外麻醉或全凭静脉麻醉用于经皮肾镜碎石术[J].重庆医学,2015,44(2):251-253.
[9]魏振铨,路中江,魏光绩.经阴囊小切口手术治疗小儿腹股沟斜疝与传统手术的对比分析[J].当代医学,2018,24(35):145-147.
[10]韩梦丽,刘春兰.硬膜外导管的发展及展望[J].河南医学研究,2018,27(20):3713-3714.
[11]黄琴,黄承云.不同剂量布比卡因联合芬太尼腰硬联合麻醉对剖宫产术麻醉效果和新生儿状况的影响[J].当代医学,2019,25(1):102-104.
[12]许泽锋.不同手术治疗方式治疗100例腹股沟疝气患者的临床效果对比[J].当代医学,2018,24(33):154-156.
[13]Zhang W,Fang C,Li J,et al,Slingle-dose,bilateral paravertebral block plus intravenous sufentanil analgesia in patients with esophageal cancer undergoing combined thoracoscopic-laparoscopic esopgagectomy:asafe and effective alternative[J].J Cardiothorac Vasc Anesth,2014,28(4):978-984.
[14]Lonnqvist PA,MacKenzie J,Soni AK,et al.Paravertebral blockade.Failure rate and comokucations[J].Anaesthesia,2015,50(9):813-815.
[15]Matyal R,Montealegre-Gallegos M,Shnider M,et al.preemptive ultra-sound-guided paravertebral block and immediate postoperative lung function[J].Gen Thorac Cardiovasc Surg,2015,63(1):43-48.
[2]张维娥,邵雪梅.腰-硬联合麻醉在高龄患者半髋关节置换术中的应用[J].临床麻醉学杂志,2011,27(2):203.
[3]赵发民,敬广霞,刘洋洋.超声引导定位与传统解剖定位行臂丛神经阻滞的临床麻醉效果分析[J].临床研究,2018,26(12):118-120.
[4]Mcdonnell JG,Curley G,Carney J,et al.The analgesic efficacy of transversus abdominis plane block after cesarean delivery:A randomized controlled trial[J].Anesth Analg,2008,106(1):186-191.
[5]赵发民,敬广霞,刘洋洋.超声引导定位与传统解剖定位行臂丛神经阻滞的临床麻醉效果分析[J].临床研究,2018,26(12):118-120.
[6]董彦,张庆,黄帆,等.超声引导下不同浓度罗哌卡因腹横肌平面阻滞用于剖宫产术后镇痛的效果[J].临床麻醉学杂志,2015,12(10):20254-21416.
[7]孟庆云,柳顺锁,刘志双.神经阻滞学[M].北京:人民卫生出版社,2013:213-214.
[8]罗中兵,张燕辉,宋晓阳,等.联合腰麻硬膜外麻醉或全凭静脉麻醉用于经皮肾镜碎石术[J].重庆医学,2015,44(2):251-253.
[9]魏振铨,路中江,魏光绩.经阴囊小切口手术治疗小儿腹股沟斜疝与传统手术的对比分析[J].当代医学,2018,24(35):145-147.
[10]韩梦丽,刘春兰.硬膜外导管的发展及展望[J].河南医学研究,2018,27(20):3713-3714.
[11]黄琴,黄承云.不同剂量布比卡因联合芬太尼腰硬联合麻醉对剖宫产术麻醉效果和新生儿状况的影响[J].当代医学,2019,25(1):102-104.
[12]许泽锋.不同手术治疗方式治疗100例腹股沟疝气患者的临床效果对比[J].当代医学,2018,24(33):154-156.
[13]Zhang W,Fang C,Li J,et al,Slingle-dose,bilateral paravertebral block plus intravenous sufentanil analgesia in patients with esophageal cancer undergoing combined thoracoscopic-laparoscopic esopgagectomy:asafe and effective alternative[J].J Cardiothorac Vasc Anesth,2014,28(4):978-984.
[14]Lonnqvist PA,MacKenzie J,Soni AK,et al.Paravertebral blockade.Failure rate and comokucations[J].Anaesthesia,2015,50(9):813-815.
[15]Matyal R,Montealegre-Gallegos M,Shnider M,et al.preemptive ultra-sound-guided paravertebral block and immediate postoperative lung function[J].Gen Thorac Cardiovasc Surg,2015,63(1):43-48.