超声引导下骶管阻滞在小儿腹腔镜下腹股沟疝手术中的应用

张广磊; 张平; 冯学会; 段瑞; 范会敏; 程峰; 胡军; 李仁虎

doi:10.16766/j.cnki.issn.1674-4152.002504

超声引导下骶管阻滞在小儿腹腔镜下腹股沟疝手术中的应用

doi: 10.16766/j.cnki.issn.1674-4152.002504

张广磊¹,
张平¹,
冯学会¹,
段瑞¹,
范会敏¹,
程峰¹,
胡军²,
李仁虎^1, ,

1.
安徽医科大学附属六安医院/六安市人民医院麻醉科, 安徽六安 237005
2.
安徽医科大学第二附属医院麻醉与围术期医学科, 安徽合肥 230601

基金项目:

国家自然科学基金项目 81901086

安徽医科大学校科研基金项目 2019xkj210

详细信息

通讯作者:
李仁虎，E-mail: lirenhu2008@163.com

中图分类号: R614.4 R656.21
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出版历程
- 收稿日期: 2021-05-12
- 网络出版日期: 2022-09-21

Application of ultrasound-guided sacral canal block in laparoscopic inguinal hernia surgery in children

1.
Department of Anesthesiology, Lu'an Hospital of Anhui Medical University, Lu'an, Anhui 237005, China

摘要

摘要: 目的探讨骶管阻滞在小儿腹腔镜疝气手术中的作用。方法选取2020年1-10月六安市人民医院择期行腹股沟疝修补术患儿90例, 美国麻醉医师协会分级Ⅰ~Ⅱ级, 年龄1~8岁, 采用随机数字表法分为对照组(C组)和骶管组(D组), 每组45例, D组在全麻插管后进行骶管穿刺, 穿刺成功后均注射0.2%罗哌卡因1 mL/kg, C组不行骶管阻滞。同时对2组患儿进行麻醉深度监测Narcotrend指数维持在C2~D1(69~47), 记录2组患儿麻醉前、骶管阻滞后5 min、手术开始时、手术结束时、拔管时的心率(HR)、平均动脉压(MAP), 拔管时、术后4、8、12、16及24 h婴幼儿疼痛评分(FLACC), 患儿术后躁动评分及躁动发生率, 恶心呕吐、尿潴留等不良反应的发生情况。结果与C组比较, D组患儿术后在拔管时[(3.75±0.71)分vs.(5.84±0.97)分]、术后4 h[(3.02±0.50)分vs.(4.88±0.71)分]、8 h[(2.91±0.36)分vs.(4.53±0.75)分]时的FLACC疼痛评分明显低于C组(均P < 0.05);苏醒时躁动评分[(2.44±0.54)分]明显低于C组[(3.29±0.69)分], 躁动发生率(6.67%)低于C组(22.22%, 均P < 0.05);2组患儿一般情况、手术时间、苏醒时间、心率、MAP以及术后不良反应发生率差异无统计学意义(均P>0.05)。结论骶管阻滞可以有效减少苏醒期躁动的发生, 具有良好的镇痛效果, 加快术后康复。
- 骶管阻滞 /
- 小儿 /
- 镇痛 /
- 苏醒期躁动
Abstract: Objective To investigate the role of sacral canal blocks in paediatric laparoscopic hernia surgery. Methods Ninety children (American Society of Anesthesiologist grade Ⅰ-Ⅱ, aged 1-8 years old) undergoing elective inguinal hernia repair in Lu'an people's hospital were divided into the control group (group C) and sacral canal group (D) by random number table method, with 45 cases in each group.Group D underwent sacral canal puncture after general anaesthesia intubation, and all patients were injected with 1 mL/kg of 0.2% ropivacaine after successful puncture, whereas group C did not have sacral canal block.The Narcotrend index (NI) was maintained at C2-D1(69-47) for both groups.The heart rate (HR) and mean arterial pressure (MAP) of children in both groups were evaluated before anaesthesia, 5 min after sacral block, at the beginning of surgery, at the end of surgery and at extubation.The children's face legs activity crying consolability (FLACC) scores were recorded at the time of extubation and 4, 8, 12, 16 and 24 h postoperatively.The postoperative agitation score, agitation incidence, nausea, vomiting and urinary retention was recorded. Results The FLACC pain scores of children in group D at tube drawing time[(3.75±0.71) points vs.(5.84±0.97) points], 4 h after operation[(3.02±0.50) points vs.(4.88±0.71) points]and 8 h after operation[(2.91±0.36) points vs.(4.53±0.75) points]were significantly lower than those in group C (all P < 0.05).When the children in group D woke up, their agitation score (2.44±0.54) and agitation incidence (6.67%) were significantly lower than those in group C[(3.29±0.69) points and 22.22%, all P < 0.05].There was no statistical significance in general situation, operation time, waking time, HR, MAP and postoperative adverse reaction incidence between the two groups of children (all P>0.05). Conclusion Sacral canal block can effectively reduce the incidence of waking agitation, which has excellent postoperative pain relief and can accelerate recovery after operation.
- Sacral canal block /
- Children /
- Analgesia /
- Emergency agitation

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图 1 穿刺针进入骶管时的超声横切面影像

注：1为骶管；2为骶骨；3为穿刺针。

Figure 1. Ultrasonic cross-sectional image of puncture needle entering sacral canal

下载: 全尺寸图片幻灯片

表 1 2组行疝气修补术患儿一般情况、手术及苏醒时间比较

Table 1. Comparison of general condition, operation and recovery time between the two groups of children undergoing hernia repair

组别	例数	性别(男/女，例)	年龄 (x±s, 月)	体重 (x±s, kg)	手术时间 (x±s, min)	苏醒时间 (x±s, min)
C组	45	40/5	35.8±16.7	17.6±3.4	25.1±3.5	30.5±4.3
D组	45	38/7	34.9±12.9	17.1±3.6	25.4±3.1	29.8±5.1
统计量		0.385^a	0.286^b	0.677^b	0.431^b	0.704^b
P值		0.535	0.774	0.464	0.694	0.742
注：^a为χ²值，^b为t值。

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表 2 2组行疝气修补术患儿围术期各时间点HR和MAP比较(x ±s)

Table 2. Comparison of HR and MAP at each time point in the perioperative period between the two groups of children undergoing hernia repair (x ±s)

组别	例数	MAP(mm Hg)					HR(次/min)
组别	例数	T0	T1	T2	T3	T4	T0	T1	T2	T3	T4
C组	45	70.2±5.3	75.1±4.3	73.5±4.2	73.8±4.2	73.6±3.5	115.2±8.7	118.6±9.2	116.3±8.8	117.5±9.2	117.3±8.5
D组	45	71.3±5.1	74.2±5.2	72.6±4.9	72.7±5.3	72.7±4.1	114.5±9.0	116.5±9.1	119.2±9.5	120.2±8.6	116.3±8.8
t值		1.003	0.895	0.935	1.091	1.120	0.375	1.088	1.502	1.438	0.548
P值		0.318	0.373	0.352	0.278	0.265	0.708	0.279	0.136	0.153	0.584

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表 3 2组行疝气修补术患儿苏醒期各时间点FLACC评分比较(x ±s，分)

Table 3. Comparison of flacc scores between the two groups at various time points in the recovery period of children undergoing hernia repair (x ±s, points)

组别	例数	拔管时	术后4 h	术后8 h	术后12 h	术后16 h	术后24 h
C组	45	5.84±0.97	4.88±0.71	4.53±0.75	2.77±0.47	1.95±0.47	1.15±0.56
D组	45	3.75±0.71^a	3.02±0.50^a	2.91±0.36^a	2.75±0.43	1.85±0.48	1.08±0.63
t值		11.663	14.368	13.062	0.211	0.998	0.557
P值		< 0.001	< 0.001	< 0.001	0.833	0.321	0.578
注：与C组比较，D组患儿在苏醒后8 h内FLACC评分明显降低，^aP＜0.05。

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表 4 2组行疝气修补术患儿躁动及术后追加镇痛药物情况比较

Table 4. Comparison of postoperative agitation and postoperative analgesia in children with hernia repair between the two groups

组别	例数	躁动发生 [例(%)]	躁动评分 (x±s，分)	追加镇痛 [例(%)]
C组	45	10(22.22)	3.29±0.69	9(20.00)
D组	45	3(6.67)	2.44±0.54	0
统计量		4.406^a	6.507^b	7.901^a
P值		0.036	< 0.001	0.005
注：^a为χ²值，^b为t值。

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表 5 2组行疝气修补术患儿围术期并发症发生情况比较(例)

Table 5. Comparison of perioperative complications between two groups of children undergoing hernia repair (cases)

组别	例数	心动过缓	低血压	恶心呕吐	尿潴留
C组	45	2	1	1	0
D组	45	1	1	1	0
注：各并发症比较，均P>0.05。

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参考文献(17)

[1]	马同胜, 刘丰丽, 曾战东, 等. 腹腔镜与传统手术治疗新生儿嵌顿性腹股沟斜疝的比较[J]. 中国微创外科杂志, 2018, 18(2): 124-126. doi: 10.3969/j.issn.1009-6604.2018.02.009 MA T S, LIU F L, ZENG Z D, et al. Comparison of laparoscopic and traditional surgery in the treatment of neonatal incarcerated indirect inguinal hernia[J]. Chinese Journal of Minimally Invasive Surgery, 2018, 18(2): 124-126. doi: 10.3969/j.issn.1009-6604.2018.02.009
[2]	中国心胸血管麻醉学会日间手术麻醉分会, 中国医学会麻醉学分会小儿麻醉学组. 小儿日间手术麻醉指南[J]. 中华医学杂志, 2019, 99(8): 566-570. doi: 10.3760/cma.j.issn.0376-2491.2019.08.002 Day surgery anesthesia branch of Chinese Cardiothoracic and Vascular Anesthesia Society, Pediatric Anesthesiology group of Chinese Medical Association. Guidelines for pediatric day surgery anesthesia[J]. Chinese Medical Journal, 2019, 99(8): 566-570. doi: 10.3760/cma.j.issn.0376-2491.2019.08.002
[3]	杨春艳, 杨瑞, 宋宇龙, 等. 麻醉管理中应用快速康复外科策略对患者免疫功能的影响[J]. 临床麻醉学杂志, 2016, 32(5): 468-471. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMZ201605016.htm YANG C Y, YANG R, SONG Y L, et al. Effect of rapid rehabilitation surgery strategy on patients ' immune function in anesthesia management[J]. Journal of Clinical Anesthesiology, 2016, 32(5): 468-471. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMZ201605016.htm
[4]	MONTIROSSO R, CASINI E, DELPRETE A, et al. Neonatal developmental care in infant pain management and internalizing behaviours at 18 months in prematurely born children[J]. Eur J Pain, 2016, 20(6): 1010-1021. doi: 10.1002/ejp.826
[5]	KAO S C, LIN C S. Caudal epidural block: An updated review of anatomy and techniques[J]. Biomed Res Int, 2017: 9217145. DOI: 10.1155/2017/9217145.
[6]	潘蓓, 程伟波, 李江悦. 超声引导下骶管阻滞在临床麻醉中的应用[J]. 中华全科医学, 2020, 18(5): 826-829. doi: 10.16766/j.cnki.issn.1674-4152.001367 PAN B, CHENG W B, LI J Y. Application of ultrasound-guided sacral block in clinical anesthesia[J]. Chinese Journal of General Practice, 2020, 18(5): 826-829. doi: 10.16766/j.cnki.issn.1674-4152.001367
[7]	MOSSETTI V, BORETSKY K, ASTUTO M, et al. Persistent pain following common outpatient surgeries in children: A multicenter study in Italy[J]. Paediatr Anaesth 2018, 28: 231-235. doi: 10.1111/pan.13321
[8]	TEUNKENS A, VERMEULEN K, PETERS M, et al. Bupivacaine infiltration in children for postoperative analgesia after tonsillectomy: A randomised controlled study [J]. Eur J Anaesthesiol, 2019, 36(3): 206-214. doi: 10.1097/EJA.0000000000000950
[9]	RABBITTS J A, FISHER E, ROSENBLOOM B N, et al. Prevalence and predictors of chronic postsurgical pain in children: A systematic reviewand meta-analysis[J]. J Pain, 2017, 18(6): 605-614. doi: 10.1016/j.jpain.2017.03.007
[10]	FERLAND C E, VEGA E, INGELMO P M. Acute pain management in children: Challengs and rencent improvements[J]. Curr Opin Anaesthesiol, 2018, 31(3): 327-332. doi: 10.1097/ACO.0000000000000579
[11]	YOSHIOKA S, TAKEDATSU H, FUKUNAGA S, et al. Study to determine guidelines for pediatric colonoscopy[J]. World J Gastroenterol, 2017, 23(31): 5773-5779. doi: 10.3748/wjg.v23.i31.5773
[12]	PONDE V C, BEDEKAR V V, DESAI A P, et al. Comparison between the Quincke's 22-gauge spinal needle and the 22-gauge hypodermic BD needle for the administration of caudal blocks in paediatric regional anaesthesia-A prospective randomised study[J]. Indian J Anaesth, 2019, 63(1): 58-60. doi: 10.4103/ija.IJA_114_18
[13]	HASSAN P F, HASSAN A S, ELMETWALLY S A. Caudal analgesia for hypospadias in pediatrics: Comparative evaluation of adjuvants dexamethasone and dex medetomidine combination versus dexamethasone or dexmedetomidine to bupivacaine: A prospective, double-blinded, randomized comparative study[J]. Anesth Essays Res, 2018, 12(3): 644-650. doi: 10.4103/aer.AER_77_18
[14]	SURESH S, ECOFFEY C, BOSENBERG A, et al. The European Society of Regional Anaesthesia and Pain Therapy/American society of Regional Anaesthesia and Pain Medicine Recommendations on local anesthetics and adjuvants dosage in pediatric regional anesthesia[J]. Reg Anesth Pain Med, 2018, 43(2): 211-216.
[15]	吴星, 郭丽丽, 叶国妹, 等. 超声评估不同容量局部麻醉药对小儿骶管阻滞注射麻醉平面的影响[J/CD]. 中华危重症医学杂志(电子版), 2017, 10(1): 40-41. WU X, GUO L L, YE G M, et al. Ultrasound evaluation of the effect of different volume local anesthetics on the anesthesia level of sacral block injection in children[J/CD]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2017, 10(1): 40-41.
[16]	SONG S Y, KWAK S G, KIM E. Effect of a mother ' s recorded voice on emergence from general anesthesia in pediatric patients: Study protocol for a randomized controlled trial[J]. Trials, 2017, 18(1): 430-435. doi: 10.1186/s13063-017-2164-4
[17]	MOORE A D, ANGHELESCU D L. Emergence delirium in pediatric anesthesia[J]. Paediatr Drugs, 2017, 19(1): 11-20. doi: 10.1007/s40272-016-0201-5