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中华疝和腹壁外科杂志(电子版)

中华疝和腹壁外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (05) : 502 -505. doi: 10.3877/cma.j.issn.1674-392X.2021.05.014

临床论著

不同麻醉方式对老年腹股沟疝无张力修补术患者麻醉效果的影响
周红娟1, 肖春龙1, 王波1, 冯传涛1, 赵伟2, 周曦3,†()   
  1. 1. 721100　陕西宝鸡市中医医院麻醉科
    2. 710061　西安交通大学第一附属医院普外科
    3. 442099　湖北省，十堰市妇幼保健院麻醉科
  • 收稿日期:2020-01-06 出版日期:2021-10-14
  • 通信作者: 周曦

Influence of different anesthesia methods on the effect of anesthesia in elderly patients undergoing tension-free inguinal hernia repair

Hongjuan Zhou1, Chunlong Xiao1, Bo Wang1, Chuantao Feng1, Wei Zhao2, Xi Zhou3,†()   

  1. 1. Department of Anesthesia, Baoji Traditional Chinese Medicine Hospital, Baoji 721100, Shaanxi Province, China
    2. Department of Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi’an 710061, China
    3. Department of Anesthesia, Shiyan Maternal and Child Health Hospital, Shiyan 442099, Hubei Province, China
  • Received:2020-01-06 Published:2021-10-14
  • Corresponding author: Xi Zhou
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周红娟, 肖春龙, 王波, 冯传涛, 赵伟, 周曦. 不同麻醉方式对老年腹股沟疝无张力修补术患者麻醉效果的影响[J]. 中华疝和腹壁外科杂志(电子版), 2021, 15(05): 502-505.

Hongjuan Zhou, Chunlong Xiao, Bo Wang, Chuantao Feng, Wei Zhao, Xi Zhou. Influence of different anesthesia methods on the effect of anesthesia in elderly patients undergoing tension-free inguinal hernia repair[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2021, 15(05): 502-505.

目的

对比不同麻醉方式对老年腹股沟疝无张力修补术患者的麻醉效果。

方法

选择2017年5月至2018年5月宝鸡市中医医院收治的90例腹股沟疝无张力修补术患者作为研究对象，按照随机数表法随机分为2组，每组45例。对照组予以持续硬膜外麻醉方式，试验组予以局部麻醉方式。比较2组患者的麻醉效果、不良反应发生率及不同时间点的平均动脉压（MAP）及心率（HR）。

结果

试验组患者的麻醉起效时间、手术时间、术后下地活动时间、住院时间及住院费用均显著优于对照组，差异均有统计学意义（均P<0.001）；试验组的不良反应发生率明及疼痛程度显低于对照组，差异均有统计学意义（均P<0.05）；试验组患者MAP水平值及HR指数在T2、T3时的指标明显优于对照组，差异均有统计学意义（均P<0.001）。

结论

局部麻醉应用于老年腹股沟疝无张力修补术中能迅速而有效降低患者疼痛程度、有利于患者术后恢复，减少不良反应发生率，值得在临床中应用和推广。

关键词: 疝，腹股沟, 疝修补术, 老年人, 麻醉
Objective

To compare the anesthesia effects of different anesthesia methods on elderly patients undergoing tension-free inguinal hernia repair.

Methods

90 patients with tension-free inguinal hernia repair in our ospital from May 2017 to May 2018 were selected as the research subjects. According to the random grouping method, they were divided into a control group and an experimental group, 45 cases in each group. The control group was given continuous epidural anesthesia, and the experimental group was given local anesthesia. The anesthesia effect, incidence of adverse reactions, mean artery pressure (MAP) and heart rate (HR) at different time points were compared between the two groups.

Results

The onset time of anesthesia, operation duration, postoperative time in the field, hospitalization duration, and hospitalization expenses of the experimental group were significantly better than those of the control group (P<0.001); the adverse reaction rate and the pain degree of the experimental group were significantly lower than those of the control group (P<0.05); the MAP and the HR index at T2 and T3 of the experimental group were significantly better than those of the control group (P<0.001).

Conclusion

Local anesthesia used in tension-free repair of the elderly inguinal hernia can quickly and effectively reduce the pain of the patient, help the patient recover after surgery, and reduce the incidence of adverse reactions. It is worthy of clinical application and promotion.

Key words: Hernia, inguinal, Herniorrhaphy, Aged, Anesthesia effect
表1 2组患者一般资料比较
临床资料 试验组(45例) 对照组(45例) χ2/t值 P值
年龄(岁,±s)     0.324 0.746
  51.35±11.25 52.08±10.05    
性别[例(%)]     0.182 0.670
男性 42(93.33) 43(95.56)    
女性 3(6.67) 2(4.44)    
体质量指数(kg/m2,±s) 25.33±1.61 26.02±1.52 2.090 0.039
美国麻醉医师协会分级[例(%)]     0.044 0.833
Ⅰ 24(53.33) 23(51.11)    
Ⅱ 21(46.67) 22(48.89)    
病理类型[例(%)]     0.200 0.655
斜疝 29(64.44) 31(68.89)    
直疝 16(35.56) 14(31.11)    
表2 2组患者手术情况比较（±s）
组别 例数 麻醉起效时间(min) 手术时间(min) 术后下地活动时间(h) 住院时间(d) 住院费用(元)
试验组 45 3.29±1.28 44.37±11.23 3.35±1.65 3.31±1.28 7457.68±323.88
对照组 45 5.39±2.15 55.36±12.57 5.49±1.88 4.65±1.65 11 783.36±528.69
t值   5.629 4.373 5.739 4.304 46.801
P值   <0.001 <0.001 <0.001 <0.001 <0.001
表3 2组患者不同时间点MAP和HR水平比较（±s）
组别 例数 MAP(mmHg) HR(次/min)
T0 T1 T2 T3 T0 T1 T2 T3
试验组 45 135.21±10.28 124.25±9.82 114.25±10.33 101.04±9.52 80.25±6.2 77.38±5.7 69.35±4.3 55.69±5.1
对照组 45 137.89±9.44 125.73±9.93 124.36±10.91 110.59±9.54 81.33±5.8 77.42±5.5 73.71±5.3 65.27±5.9
t值   1.288 0.711 4.513 4.753 0.853 0.034 4.285 8.24
P值   0.201 0.479 <0.001 <0.001 0.396 0.973 <0.001 <0.001
表4 2组不良反应发生率比较
组别 例数 恶心呕吐(例) 阴囊水肿(例) 尿潴留(例) 不良反应发生率(%)
试验组 45 1 0 1 4.44a
对照组 45 3 2 2 15.56
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