摘要
目的探究超声引导下髂腹股沟-髂腹下神经阻滞(IINB)联合腹横肌平面阻滞(TAPB)对老年腹股沟疝修补术患者术中心率、血压与术后镇痛效果及应激反应的影响。方法选取2020年4月至2022年2月于长江大学附属仙桃市第一人民医院行腹股沟疝Lichtenstein术治疗的老年患者86例,行前瞻性研究,按随机数表法分为对照、观察组,每组43例。对照组予超声引导下的IINB,观察组行超声引导下的IINB联合TAPB。比较2组患者进入手术室(T0)、切皮(T1)、缝皮(T2)时的心率、收缩压、舒张压,不同时点镇痛效果,术后应激指标[肿瘤坏死因子-α(TNF-α),C反应蛋白(CRP),皮质醇]及术后不良反应发生情况。结果T0时刻,2组心率、收缩压、舒张压比较差异无统计学意义(P>0.05),T1时刻观察组心率、收缩压显著低于对照组,T2时刻观察组收缩压显著低于对照组,差异有统计学意义(P<0.05)。观察组术后2、4、8、12、24 h视觉模拟评分低于对照组,差异有统计学意义(P<0.05)。术前,2组CRP、TNF-α、皮质醇比较差异无统计学意义(P>0.05),术后1、3 d,观察组CRP、TNF-α、皮质醇明显低于对照组,差异有统计学意义(P<0.05)。86例患者麻醉并发症发生率为5.81%(5/86),2组并发症发生率比较差异无统计学意义(P>0.05)。结论超声引导下IINB联合TAPB对稳定老年腹股沟疝修补术患者心率、收缩压、舒张压效果更好,可提高镇痛效果,改善应激反应,且安全性有保障。
Objective To explore the effects of ultrasound-guided ilioinguinal and inferior iliac nerve block(IINB)combined with transversus abdominis plane block(TAPB)on heart rate,blood pressure,postoperative analgesia and stress response in elderly patients undergoing inguinal hernia repair..Methods A prospective study method was used to select 86 elderly patients who received inguinal hernia Lichtenstein treatment in Xiantao First People's Hospital Affiliated to Yangtze University from April 2020 to February 2022,and were divided into control group and observation group according to random number table method,with 43 cases in each group.The control group received ultrasound guided IINB,and the observation group received ultrasound guided IINB combined with TAPB.The heart rate,systolic blood pressure,diastolic blood pressure,analgesic effect at different time points,postoperative stress index(TNF-α),C-reactive protein(CRP),cortisol and postoperative adverse reactions were compared between the two groups when entering the operating room(T0),skin resection(T1)and skin suture(T2).Results At T0,there was no statistical significance in heart rate,systolic blood pressureor diastolic blood pressure between the two groups(P>0.05).The heart rate and systolic blood pressure in the observation group at T1 were significantly lower than those in the control group,and the systolic blood pressure in the observation group at T2 was significantly lower than that in the control group,with statistical significance(P<0.05).The VAS scores of the observation group at 2,4,8,12 and 24 hours after operation were lower than those of the control group,and the difference was statistically significant(P<0.05).Before surgery,CRP,TNF-α and cortisol were not significantly different between the two groups(P>0.05).1 and 3 days after surgery,CRP,TNF-α and cortisol in the observation group were significantly lower than those in the control group,with statistical significance(P<0.05).The incidence of anesthesia complications in 86 patients was 5.81%(5/86),and there was no significant difference between the two groups(P>0.05).Conclusion Ultrasound-guided IINB combined with TAPB has a better effect on stabilizing heart rate,systolic blood pressure and diastolic blood pressure in elderly patients undergoing inguinal hernia repair,and can improve analgesic effect and stress response,with guaranteed safety.
作者
谢文龙
周建军
Xie Wenlong;Zhou Jianjun(Department of Anesthesiology,Xiantao First People's Hospital Affiliated to Changjiang University,Xiantao,433000,China)
出处
《中华疝和腹壁外科杂志（电子版）》
2023年第5期588-592,共5页
Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)
关键词
髂腹股沟-髂腹下神经阻滞
腹横肌平面阻滞
疝
腹股沟
疝修补术
镇痛
应激反应
Ilioinguinal and inferior iliac nerve block
Transverse abdominal muscle plane block
Hernia,inguinal
Herniorrhaphy
Analgesia
Stress response
作者简介
通信作者:谢文龙,Email:359531966@qq.com
