摘要
目的探讨分析骶管阻滞复合全身麻醉对小儿腹腔镜斜疝手术患者苏醒期躁动及应激反应的影响。方法选择2019年1月至2022年1月在阜南县人民医院行腹腔镜手术治疗的腹股沟斜疝患儿108例,随机数字表法分为骶管阻滞组55例和对照组53例。对照组采取喉罩全身麻醉,骶管阻滞组采用骶管阻滞复合喉罩全身麻醉。观察并比较放置喉罩前(T0)、建立气腹时(T1)、拔除喉罩5 min(T2)时两组患儿平均动脉压(MAP)、心率、血氧饱和度(SpO_(2))、去甲肾上腺素(NA)以及皮质醇的变化;术毕苏醒拔除喉罩,送入麻醉后监测治疗室(PACU)即刻、5 min、15 min以及30 min两组患儿麻醉苏醒期躁动评分(PAED);术后镇痛处理及不良反应发生情况。结果MAP、心率对照组在T1、T2时刻较T0时刻显著升高(P<0.05),骶管阻滞组仅T2时刻MAP较T0显著升高(P<0.05),对照组MAP、心率在T1、T2时刻均显著高于骶管阻滞组(P<0.05)。T1、T2时刻SpO_(2)对照组较T0时刻显著降低(P<0.05);且显著低于骶管阻滞组(P<0.05)。T1、T2时刻,两组患儿NA及皮质醇水平均较T0显著升高(P<0.05);但骶管阻滞组患儿NA及皮质醇水平显著低于对照组(P<0.05)。入PACU即刻、5 min及15 min,骶管阻滞组患儿PAED评分均显著低于对照组(P<0.05)。对照组患儿术后注射曲马多、恶心呕吐、术中体动、苏醒期躁动以及气道辅助处理发生率均显著高于骶管阻滞组(P<0.05)。结论骶管阻滞复合喉罩全身麻醉用于儿童腹腔镜斜疝手术,可减少患儿苏醒期躁动、降低麻醉不良反应发生率,提供良好的术后镇痛,同时能抑制患儿术中应激反应,提供更佳的术中麻醉效果。
Objective To investigate and analyze the influence of caudal block combined with general anesthesia on postoperative agitation and stress responses in pediatric patients undergoing laparoscopic indirect inguinal hernia repair.Methods A total of 108 pediatric patients who underwent laparoscopic indirect inguinal hernia repair at Fufan County People's Hospital from January 2019 to January 2022 were enrolled.They were randomly divided into the caudal block group(55 patients)and the control group(53 patients)using a random number table.The control group received general anesthesia with a laryngeal mask,while the caudal block group received caudal block combined with general anesthesia using a laryngeal mask.The mean arterial pressure(MAP),heart rate,oxygen saturation(SpO_(2)),norepinephrine(NA)levels,and cortisol levels were observed and compared before laryngeal mask placement(T0),during pneumoperitoneum(T1),and 5 minutes after removing the laryngeal mask(T2).Pediatric anesthesia emergence delirium scale(PAED)were assessed immediately upon arrival in the Post Anesthesia Care Unit(PACU),as well as 5,15,and 30 minutes later.Postoperative analgesic administration and adverse events were also recorded.Results In the control group,the MAP and heart rate were significantly increased at T1 and T2 compared to T0(P<0.05).In the caudal block group,only the MAP at T2 was significantly elevated compared to T0(P<0.05).MAP and heart rate in the control group were significantly higher than in the caudal block group at T1 and T2(P<0.05).The SpO_(2)levels in the control group at T1 and T2 were significantly decreased compared to T0(P<0.05)and were significantly lower than in the caudal block group(P<0.05).Both groups displayed significantly elevated levels of NA and cortisol at T1 and T2 compared to T0(P<0.05),but the levels in the caudal block group were notably lower than in the control group(P<0.05).Upon arrival at PACU and at 5 and 15 minutes postoperatively,the PAED scores in the caudal block group were significantly lower than in the control group(P<0.05).Incidences of postoperative tramadol administration,nausea and vomiting,intraoperative movement,postoperative agitation,and airway auxiliary management were all notably higher in the control group compared to the caudal block group(P<0.05).Conclusion Caudal block combined with general anesthesia using a laryngeal mask for pediatric laparoscopic indirect inguinal hernia repair can reduce postoperative agitation,decrease the rate of anesthesia-related adverse reactions,provide effective postoperative analgesia,and suppress intraoperative stress responses,thus offering superior anesthetic outcomes.
作者
彭涛
吴志福
张俊生
Peng Tao;Wu Zhifu;Zhang Junsheng(Department of Anesthesia,People's Hospital of Funan County,Fuyang 236300,Anhui,China)
出处
《中华疝和腹壁外科杂志（电子版）》
2023年第4期449-453,共5页
Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)
基金
吴阶平医学基金会临床科研专项资助基金(320.6750.17377)
关键词
骶管阻滞
全身麻醉
儿童
腹腔镜
斜疝
疝修补术
Caudal block
General anesthesia
Children
Laparoscope
Indirect hernia
Herniorrhaphy
作者简介
通信作者:彭涛,Email:544853587@qq.com
