目的

探讨老年腹股沟疝患者在疝修补术中行超声引导下腹横肌平面阻滞联合腹外斜肌平面阻滞麻醉的应用效果。

方法

选择2022年2月至2023年2月解放军第九〇一医院收治的老年男性腹股沟疝患者60例。按随机数字表法分为试验组及对照组，每组患者30例。试验组行超声引导下腹横肌平面阻滞联合腹外斜肌平面阻滞麻醉，对照组行局部浸润麻醉。记录手术过程中心率、血压变化情况，麻醉药液用量，患者及术者的满意度，术中因疼痛追加麻醉的次数，术中及术后24 h内的视觉模拟评分法（VAS）评分，术后不良反应。

结果

2组均顺利完成手术，试验组患者术中VAS评分≥4分的例数、血压上升、心率加快、追加麻醉的例数均少于对照组（P＜0.05）。2组麻醉药液用量，术后24 h内VAS评分≥4分的例数及术后切口脂肪液化和阴囊水肿发生率比较，差异均无统计学意义（P＞0.05）。试验组患者术后术区皮肤青紫例数要少于对照组（P＜0.05）；试验组中患者和术者的满意度也优于对照组（90.00%比66.67%；85.67%比63.33%），差异均有统计学意义（P＜0.05）。

结论

老年患者行腹股沟疝修补术，采用超声引导下腹横肌联合腹外斜肌双平面阻滞麻醉，镇痛效果明确，术中不良反应少，可获得更好的患者及术者的满意度。

Objective

To explore the effect of ultrasound-guided transversus abdominis plane block combined with external oblique plane block anesthesia in elderly patients during hernia repair surgery.

Methods

Sixty elderly male patients with inguinal hernia who were admitted to the 901th Hospital of PLA from February 2022 to February 2023 were selected. They were randomly divided into experimental group （n=30） and control group （n=30） according to the random number table method. The experimental group underwent ultrasound-guided transversus abdominis plane block combined with external oblique muscle plane block anesthesia， and the control group underwent local infiltration anesthesia. The changes in heart rate and blood pressure during the operation， the amount of anesthetic liquid， the satisfaction of the patient and the surgeon， the number of additional anesthesia due to pain during the operation， the visual analogue scale （VAS） score during the operation and within 24 hours after the operation， and the adverse reactions after the operation were recorded.

Results

Both groups completed the operation successfully. In the experimental group， the number of patients with intraoperative VAS score ≥4 points， elevated blood pressure， increased heart rate， and additional anesthesia were less than that of the control group （P＜0.05）. There were no significant differences between two groups in the amount of anesthetic liquid， cases with VAS score ≥4 points within 24 hours after operation， and the incidence of postoperative incision fat liquefaction and scrotal edema （P＞0.05）. The number of skin bruising in the operation area of the experimental group was less than that of the control group （P＜0.05），and the satisfaction of patients and surgeons in the experimental group was also better than that of the control group （90.00% vs 66.67%； 85.67% vs 63.33%）， with statistically significant difference （P＜0.05）.

Conclusion

For elderly patients who underwent inguinal hernia repair， the ultrasound-guided transversus abdominis plane block combined with external oblique dual plane block anesthesia can obtain better analgesic effect， fewer intraoperative adverse reaction， and a higher degree of patients and surgeons' satisfaction.