微创医学

目的探究超声引导下腹直肌鞘联合腹横肌平面神经阻滞（TAPB）对小儿日间腹腔镜手术术中及术后镇痛效果的影响。方法选择行日间腹腔镜下疝囊高位结扎手术的患儿90例，随机分成A、B、C三组，每组30例。三组常规行气管插管全身麻醉，并予泵注丙泊酚及瑞芬太尼维持全身麻醉，其中A组在超声引导下行TAPB；B组在超声引导下行腹直肌鞘阻滞（RSB）联合TAPB；C组未行任何神经阻滞麻醉。比较三组术中用药情况，停用全麻药物后气管导管拔除时间，术后1 h、3 h、6 h、12 h、24 h的疼痛评估量表（FLACC）评分和Ramsay镇静评分，以及药物安全性。结果与A、C组相比，B组患儿瑞芬太尼、丙泊酚用量少，气管导管拔除时间早，且术后1 h、3 h、6 h的FLACC评分低，术后1 h、3 h的Ramsay评分高（均P＜0.05）。术后6 h，B组的Ramsay评分高于C组（P＜0.05）。三组患儿术后12 h、24 h的FLACC和Ramsay评分差异均无统计学意义（均P＞0.05）。每组各有2例患儿出现不良反应情况，发生率为 6.67%，组间对比，差异无统计学意义（P＞0.05）。结论超声引导下RSB联合TAPB麻醉在小儿日间腹腔镜手术中有较好的临床效果，可明显缓解术后早期疼痛，减少麻醉药物用量，具有较高的安全性，值得推广应用。

ObjectiveTo explore the intra- and post-operative analgesis effects of ultrasound-guided sheath of rectus abdominis combined with transversus abdominis plane block (TAPB) on pediatric laparoscopic surgery in the daytime. MethodsA total of 90 children undergoing laparoscopic high ligation of hernia sac in the daytime were selected and randomly divided into group A, group B and group C, with 30 cases in each group. All of the groups underwent conventional general anesthesia with trachea cannula, and then with intravenous pumping of propofol and remifentanil to maintain general anesthesia, of which group A conducted the ultrasound-guided TAPB, group B underwent the ultrasound-guided rectus sheath block (RSB) and TAPB, and group C did not receive any nerve block for anesthesia. Intraoperative medication conditions, extubation time of tracheal catheter after the withdrawal of anesthetic drugs, the face, legs, activity, cry, consolability (FLACC) scale and Ramsay scores at 1, 3, 6, 12, 24 hours after surgery, as well as medication safety were compared between the three groups. ResultsCompared to group A and group C, group B yielded fewer dosage of remifentanil and propofol, earlier extubation time of tracheal catheter, lower FLACC scores at 1, 3 and 6 hours after surgery, whereas higher Ramsay scores at 1,3 hours after surgery (all P＜0.05). Six hours after surgery, group B yielded a higher Ramsay score as compared with group C (P＜0.05). There were no statistically significant differences in FLACC and Ramsay scores between the three groups 12 and 24 hours after surgery (all P＞0.05). Adverse reactions occurred in two children in each group, with an incidence of 6.67%, and there was no statistically significant difference in the incidence between the three groups (P＞0.05). ConclusionThe ultrasound-guided RSB combined with TAPB has a good clinical effect for pediatric laparoscopy surgery in the daytime, which can significantly relieve the early postoperative pain, reduce the dosage of anesthetic drugs, with high safety. Thus it is worthy of promotion and application.