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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) ›› 2022, Vol. 16 ›› Issue (03) : 278 -281. doi: 10.3877/cma.j.issn.1674-392X.2022.03.007

临床论著

全身麻醉复合髂腹股沟-髂腹下神经阻滞在老年腹腔镜疝修补术中的效果
李慧慧1, 蔡宁1,†(), 官双双1, 杨康1, 李中心1   
  1. 1. 236000　安徽省，阜阳市人民医院麻醉科
  • 收稿日期:2021-12-23 出版日期:2022-06-20
  • 通信作者: 蔡宁
  • 基金资助:
    阜阳市卫生健康委科研课题(fy2019-36)

Efficacy of general anesthesia combined with ilioinguina-iliohypoabdominal nerve block in laparoscopic hernia repair in elderly patients

Huihui Li1, Ning Cai1,†(), Shuangshuang Guan1, Kang Yang1, Zhongxin Li1   

  1. 1. Department of Anesthesiology, Fuyang City People's Hospital, Fuyang 236000, Anhui Province, China
  • Received:2021-12-23 Published:2022-06-20
  • Corresponding author: Ning Cai
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引用本文：

李慧慧, 蔡宁, 官双双, 杨康, 李中心. 全身麻醉复合髂腹股沟-髂腹下神经阻滞在老年腹腔镜疝修补术中的效果[J/OL]. 中华疝和腹壁外科杂志(电子版), 2022, 16(03): 278-281.

Huihui Li, Ning Cai, Shuangshuang Guan, Kang Yang, Zhongxin Li. Efficacy of general anesthesia combined with ilioinguina-iliohypoabdominal nerve block in laparoscopic hernia repair in elderly patients[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2022, 16(03): 278-281.

目的

对比全身麻醉复合髂腹股沟-髂腹下神经阻滞和全身麻醉在老年腹腔镜疝修补术中的应用效果。

方法

选择2020年1月至2021年8月于阜阳市人民医院收治的70例老年腹股沟疝患者参与研究，随机分为2组，每组患者35例。观察组采用全身麻醉复合髂腹股沟-髂腹下神经阻滞麻醉，对照组采用全身麻醉。记录2组患者不同时段的平均动脉压（MAP）和心率（HR）水平，分别在术后即刻、术后6、12 h评估2组患者的Ramsay、疼痛视觉模拟评分（VAS），分析2组患者的麻醉复苏质量和麻醉效果。

结果

T1、T2、T3时，2组患者的MAP、HR水平较T0均显著降低，而观察组显著高于对照组（P<0.05）。术后6、12 h，2组患者的Ramsay评分较术后即刻显著降低，且观察组显著低于对照组；2组患者的VAS评分较术后即刻显著升高，而观察组显著低于对照组（P<0.05）。术后，观察组患者的拔管时间、清醒时间、离开手术室时间均显著低于对照组（P<0.05）；观察组患者的麻醉优良率为97.14%，稍高于对照组的88.57%，差异无统计学意义（P>0.05）。

结论

全身麻醉复合髂腹股沟-髂腹下神经阻滞全身麻醉在老年腹腔镜疝修补术中的麻醉可有效维持血流动力学稳定，具有良好的镇静、镇痛、麻醉复苏质量，可作为老年腹股沟疝患者腹腔镜疝修补术的优先选择。

关键词: 髂腹股沟-髂腹下神经阻滞, 全身麻醉, 腹腔镜, 疝修补术, 疝，腹股沟
Objective

To compare the effects of general anesthesia combined with ilioinguina-iliohypoabdominal nerve block and general anesthesia in laparoscopic hernia repair in the elderly.

Methods

A total of 70 elderly patients with inguinal hernia admitted to Fuyang People's Hospital from January 2020 to August 2021 were selected to participate in the study. The patients were randomly divided into two groups: observation group (35 cases) received general anesthesia combined with ilioinguina-iliohypoabdominal nerve block, and control group (35 cases) received general anesthesia. Mean arterial pressure (MAP) and heart rate (HR) levels at different time periods were recorded in 2 groups, Ramsay and visual analogue scale (VAS) scores were evaluated immediately, 6 and 12 hours after surgery, respectively, and anesthesia recovery quality and anesthesia effect were analyzed in 2 groups.

Results

At T1, T2 and T3, MAP and HR levels in 2 groups were significantly lower than those in T0, and MAP and HR levels in the observation group was significantly higher than that in the control group (P<0.05). At 6 h and 12 hours after surgery, Ramsay score of 2 groups was significantly lower than that immediately after surgery, and Ramsay score in the observation group was significantly lower than that in the control group. The VAS scores of the two groups were significantly higher than that immediately after the operation, while the VAS scores of the observation group was significantly lower than that of the control group (P<0.05). After operation, the extubation time, awake time, and time to leave the operation in observation group were significantly lower than those in the control group (P<0.05). The excellent and good rate of anesthesia of the observation group was 97.14%, which was slightly higher than 88.57% of the control group, with no statistically significant difference (P>0.05).

Conclusion

General anesthesia combined with ilioinguina-iliohypoabdominal nerve block can effectively maintain hemodynamic stability and has good sedation, analgesia and anesthetic recovery quality in elderly patients with laparoscopic inguinal hernia repair, which can be a priority choice for elderly patients with laparoscopic inguinal hernia repair.

Key words: Ilioinguino-iliohypoabdominal nerve block, General anesthesia, Laparoscopes, Herniorrhaphy, Hernia, inguinal
表1 2组患者不同时段的平均动脉压比较（mmHg，±s）
组别 例数 T0 T1 T2 T3
观察组 35 85.23±3.49 81.88±3.25# 82.52±2.56# 84.23±3.46#
对照组 35 85.13±3.31 76.49±2.02# 78.86±2.37# 80.77±4.21#
t值   0.12 8.33 6.21 3.76
P值   0.90 <0.001 <0.001 <0.001
表2 2组患者不同时段的心率比较（次/min，±s）
组别 例数 T0 T1 T2 T3
观察组 35 72.32±3.47 68.75±2.45# 70.59±2.57# 71.25±3.13#
对照组 35 72.31±3.71 64.44±2.32# 66.47±2.46# 68.68±2.27#
t值   0.01 7.56 6.85 3.93
P值   0.99 <0.001 <0.001 <0.001
表3 2组患者不同时段Ramsay评分比较（分，±s）
组别 例数 术后即刻 术后6 h 术后12 h
观察组 35 5.23±0.42 2.63±0.45# 2.11±0.33#
对照组 35 5.25±0.41 3.49±0.72# 2.82±0.62#
t值   0.20 5.99 5.98
P值   0.84 <0.001 <0.001
表4 2组患者不同时段疼痛视觉模拟评分比较（分，±s）
组别 例数 术后即刻 术后6 h 术后12 h
观察组 35 1.62±0.12 2.13±0.42# 2.72±0.56#
对照组 35 1.56±0.21 3.12±0.61# 4.26±1.07#
t值   1.47 7.91 7.54
P值   0.15 <0.001 <0.001
表5 2组患者麻醉复苏质量比较（min，±s）
组别 例数 拔管时间 清醒时间 离开手术室时间
观察组 35 5.42±3.18 9.65±1.48 16.72±3.53
对照组 35 7.37±3.94 11.47±2.26 24.88±3.35
t值   2.28 3.99 9.92
P值   0.03 <0.001 <0.001
表6 2组患者麻醉效果比较
组别 例数 优(例) 良(例) 差(例) 优良率[例(%)]
观察组 35 24 10 1 34(97.14)#
对照组 35 19 12 4 31(88.57)
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