探究超声引导下腹横肌平面阻滞联合喉罩全麻下小儿疝囊高位结扎术的镇痛效果。

选取2016年1月至2018年1月，湖北省洪湖市人民医院150例接受疝囊高位结扎术的患儿，随机分为观察组（75例）和对照组（75例）。对照组采用单纯喉罩全身麻醉，而观察组在对照组基础上进行超声引导下腹横肌平面阻滞。比较2组患儿的平均动脉压（MAP）、心率（HR）、躁动及疼痛评分、苏醒时间、手术时间及并发症发生状况。

观察组的并发症发生率（6.7%）低于对照组（17.3%），差异有统计学意义（P<0.05）。观察组患儿手术时间、苏醒时间、躁动评分、12 h小儿疼痛量表（12 h FLACC）评分均低于对照组（P<0.05）。观察组插入喉罩后、手术开始时、拔除喉罩时与麻醉诱导前比较，MAP、HR差异均无统计学意义（P>0.05）；对照组插入喉罩后、拔除喉罩时与麻醉诱导前比较，MAP、HR差异均无统计学意义（P>0.05），手术开始时MAP、HR高于麻醉诱导前（P<0.05）。麻醉诱导前、插入喉罩后、拔除喉罩时2组间的MAP、HR差异均无统计学意义（P>0.05），手术开始时，观察组的MAP、HR均低于对照组（P<0.05）。

小儿疝囊高位结扎术中应用超声引导下腹横肌平面阻滞联合喉罩全麻的麻醉效果较好，术后苏醒快，可以缓解患儿术后疼痛及躁动，降低并发症的发生率，具有临床应用价值。

To explore the analgesic effect of ultrasound guided transverse abdominis plane block combined with laryngeal mask general anesthesia on high ligation of hernia sac in children.

150 children undergoing high ligation of hernia sac were randomly divided into the observation group (75 cases) and the control group (75 cases). The control group was treated with laryngeal mask general anesthesia, while the observation group was treated with ultrasound guided transverse abdominis plane block on the basis of the control group. The mean arterial pressure (MAP), heart rate (HR), restlessness and pain scores, recovery time, operative time and complications were compared between the two groups.

The incidence of complications in the observation group was significantly lower than that in the control group (6.7% vs 17.3%, P<0.05). The operation time, recovery time, restlessness score and 12 h FLACC score in the observation group were lower than those in the control group (P<0.05). In the observation group, there was no significant difference in MAP, HR when the laryngeal mask was inserted, the surgery start time, the laryngeal mask was removed and before anesthesia induction (P>0.05). In the control group, there was no significant difference in MAP, HR when the laryngeal mask was inserted, the laryngeal mask was removed and before anesthesia induction (P>0.05). The MAP, HR at the beginning of operation in the control group was higher than that before anesthesia induction (P<0.05). There was no significant difference in MAP, HR between the two groups (P>0.05) when period before anesthesia induction, the laryngeal mask was inserted ,and after inserting laryngeal mask. At the beginning of operation, the MAP, HR of the observation group was lower than that of the control group (P<0.05).

Ultrasound-guided transverse abdominis plane block combined with laryngeal mask general anesthesia in high ligation of hernia sac in children can effectively reduce the operation time and postoperative recovery time, relieve postoperative pain and restlessness, and reduce the incidence of complications. It has great clinical application value.