探究超声引导下髂腹股沟-髂腹下神经阻滞在老年腹股沟疝手术中的应用及其安全性。

选择2018年7月至2019年11月，安徽省芜湖市第五人民医院行老年腹股沟疝手术64例患者的病例资料。美国麻醉医师协会分级Ⅰ～Ⅲ级，年龄60～85岁，体质量指数18～25 kg/m²，采用随机数字表法随机分为对照组和观察组，每组32例。对照组给予腰椎麻醉；观察组患者超声引导下髂腹股沟-髂腹下神经阻滞麻醉。比较2组进入手术室时（T0）、麻醉完成后5 min（T1）、切皮后（T2）、手术结束时（T3）、术后6 h（T4）不同时刻的血流动力学指标，包括脉搏血氧饱和度（SpO₂）、平均动脉压（MAP）及心率（HR）。对比2组患者术后时刻、术后6 h、术后12 h的视觉模拟评分法（VAS）；对比2组患者住院时间、麻醉满意度评分及术后恢复活动的时间；对比T0、T3、T4胃泌素（GAS）和胃动素（MTL）；记录2组患者术后24 h的并发症及不良反应。

2组SpO₂在T0～T4不同时刻比较，差异无统计学意义（P>0.05）。对照组HR在T1～T3时刻显著低于T0时刻，而且对照组的MAP在T1、T2、T3时刻较观察组低，两者差异有统计学意义（P<0.05）。观察组患者在术后6 h VAS评分低于对照组，2组比较差异有统计学意义（t=3.690，P<0.05）。观察组手术时间、术后恢复活动时间较对照组短，麻醉满意度评分高于对照组，2组比较差异均有统计学意义（t=3.473，2.845，3.097；P<0.05）2组患者在T4时GAS、MTL的表达水平差异有统计学意义（P<0.05），T3时刻均较T0时刻低，说明手术影响胃肠激素水平表达，观察组T4时刻较对照组高（P<0.05），说明观察组术后胃肠道恢复优于对照组。观察组患者恶心呕吐的发生率低于对照组，较差异有统计学意义（P<0.05），其他不良反应对比差异无统计学意义（P>0.05）。

在超声引导下对老年腹股沟疝患者使用髂腹股沟-髂腹下神经阻滞术，能减少老年患者的生理影响，加快患者的术后肠胃功能，降低恶心呕吐发生率，值得推广。

To evaluate the application and safety of ultrasound-guided ilioinguinal-iliohypogastric nerve block in the operation of inguinal hernia in the elderly.

64 elderly patients who underwent inguinal hernia surgery in the Fifth People's Hospital of Wuhu from July 2018 to November 2019 were selected as study subjects. With ASA gradeⅠ-Ⅲ, age 60 to 85 years old, BMI 18 to 25 kg/m², the patients were divided into control group (n=32, lumbar anesthesia) and observation group (n=32, ultrasound-guided ilioinguinal-iliohypogastric nerve block) by random number table method. Compare the two groups at entering the operating room (T₀), 5 mintes after the completion of anesthesia (T₁), cutting skin (T₂), at the end of surgery (T₃), 6 hours after surgery (T₄) with hemodynamic indexes of different time [pulse oxygen saturation (SpO₂), mean arterial pressure (MAP), heart rate (HR)], compared two groups of patients with postoperative pain degree (VAS score) at immediate postoperative time, postoperative 6 hours, and 12 hours; compared two groups of patients anesthesia satisfaction score, postoperative recovery time, and length of stay; Gastrointestinal hormone levels at T₀, T₃ and T₄ [gastrin (GAS) and motilin (MTL)] were compared; and complications and adverse reactions at 24 h after operation were recorded in the two groups.

There was no significant difference in SpO₂ between the two groups at T₀-T₄ (P>0.05). Compared with T₀, HR at T₁-T₃ in the control group was significantly lower, and MAP at T₁, T₂ and T₃ in the control group were lower than those in the observation group (P<0.05). VAS score at 6h after operation in the observation group was lower than that in the control group (P<0.05). The operative time and postoperative activity recovery time of the observation group were shorter than those of the control group, and the anesthesia satisfaction score was higher than that of the control group (P<0.05). The expression levels of GAS and MTL were significantly different between the two groups at different time points (P<0.05). The expression levels of GAS and MTL were both lower at T₃ than at T₀, while the expression levels of GAS and MTL were higher in the observation group than the control group at T₄ (P<0.05). The incidence of nausea and vomiting in the observation group was lower than that in the control group (P<0.05), and there was no significant difference in other adverse reactions.

The application of ultrasound-guided ilioinguinal iliac hypogastric nerve block in the operation of inguinal hernia in the elderly can reduce the physiological influence of the elderly patients, accelerate gastrointestinal function after the operation, and reduce the incidence of nausea and vomiting, and it is worthy of promotion.