比较两种腹横肌平面（TAP）阻滞方法在老年择期腹股沟疝修补术中的应用效果。

选取2021年1月至2022年12月于南京中医药大学附属南京医院择期行腹股沟疝修补术的老年患者90例，使用随机数字表法将患者分为对照组（45例，超声引导下侧路TAP阻滞）和观察组（45例，超声引导下TAP两点阻滞），观察并比较2组围手术期指标、血流动力学参数、镇痛效果及应激指标，并观察恶心、呕吐等麻醉不良反应发生情况。

2组患者的疝环直径、手术时间及术中出血等手术情况差异无统计学意义（P>0.05），观察组术后下床时间和住院时间较对照组缩短，差异有统计学意义（P<0.05）。手术开始后10 min、手术结束时2组的心率、平均动脉压（MAP）均较麻醉前下降（P<0.05），且观察组均高于对照组，差异有统计学意义（P<0.05）。术后24 h，2组患者静息及活动时疼痛视觉模拟评分（VAS）均较术后6、12 h降低，且术后6、12、24 h时观察组患者静息和活动时疼痛VAS评分明显低于对照组（P<0.05）。术前，2组患者白细胞介素（IL）-6、皮质醇和胰岛素指标差异无统计学意义（P>0.05），术后1、3 d 2组患者IL-6、皮质醇明显升高，但观察组明显低于对照组（P<0.05）；术后1、3 d，观察组胰岛素未见明显改变，而术后1 d对照组胰岛素明显低于术前，且与观察组比较差异有统计学意义（P<0.05）。治疗期间，观察组不良反应发生率明显低于对照组（P<0.05）。

超声引导下腹横肌平面两点阻滞具有镇痛效果佳，血流动力学稳定，应激反应小及不良反应少的优点，可提高老年腹股沟疝修补术患者的手术舒适度及安全性，利于患者康复。

To compare the effects of two transverse abdominis plane (TAP) block methods in geriatric elective inguinal hernia repair.

A total of 90 elderly patients who underwent selective inguinal hernia repair in the Second Hospital of Nanjing, Nanjing University of Chinese Medicine from January 2021 to December 2022 were selected and randomly divided into a control group (45 cases, ultrasound-guided lateral TAP block) and an observation group (45 cases, ultrasound- guided two-point block of the transverse abdominis plane). Perioperative indicators, hemodynamic parameters, analgesic effects and stress indicators were compared between the two groups. Adverse reactions were observed. Additionally, the incidence of anesthesia-related adverse reactions such as nausea and vomiting was monitored.

There was no statistically significant difference in the diameter of hernia ring, operation time, or intraoperative blood loss between the two groups (P>0.05). The postoperative ambulation time and hospital stay of the observation group were shorter than those of the control group (P<0.05). The heart rate and mean arterial pressure (MAP) of both groups decreased 10 minutes after the start of the surgery and at the end of the operation (P<0.05). The heart rate and MAP of the observation group were higher than those of the control group (P<0.05). At 24 hours after surgery, the visual analogue scores (VAS) at rest and during activity in the two groups were lower than those at 6 h and 12 h after surgery, and the VAS scores of pain at rest and during activity in the observation group were significantly lower than those in the control group at 6, 12 and 24 hours after surgery (P<0.05). On days 1 and 3 after the operation, the levels of interleukin (IL)-6 and cortisol in both groups increased significantly, and the levels in the observation group were significantly lower than those in the control group (P<0.05). There was no significant change of insulin level in the observation group on day 1 and day 3 after operation. The insulin level in the control group on day 1 after operation was significantly lower than that before operation, and there was a significant difference as compared with the observation group (P<0.05). The incidence of adverse reactions in the observation group was significantly lower than that in the control group (P<0.05).

Ultrasound-guided two-point TAP block has the advantages of a good analgesic effect, stable hemodynamics, a mild stress response and few adverse reactions. It can improve the comfort level and safety of elderly patients undergoing inguinal hernia repair, and is beneficial for recovery.