文章摘要
腹横平面阻滞在老年高危患者腹股沟疝修补术中的应用
Application of TAP nerve block as the main anesthesia method in the inguinal hernia repair in elderly patients with high risk
  
DOI：10.12089/jca.2018.07.004
中文关键词: 腹横平面阻滞  腹股沟疝修补术  VAS评分
英文关键词: Transversus abdominis plane nerve block  Inguinal hernia repair  VAS score
基金项目:新疆维吾尔自治区自然科学基金（2017D01C144）
作者单位E-mail
徐桂萍 830000,乌鲁木齐市,新疆维吾尔自治区人民医院麻醉科 xgpsyl@126.com 
潘阳阳 830000,乌鲁木齐市,新疆维吾尔自治区人民医院麻醉科  
乔南南 830000,乌鲁木齐市,新疆维吾尔自治区人民医院麻醉科  
阿里木江·司马义 830000,乌鲁木齐市,新疆维吾尔自治区人民医院麻醉科  
马雪萍 830000,乌鲁木齐市,新疆维吾尔自治区人民医院麻醉科  
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中文摘要:
      
目的 探讨腹横平面阻滞在腹股沟疝修补术中应用的安全性和有效性。

方法 选择择期行腹股沟疝修补术的患者40例, 男35例, 女5例, 年龄70～83岁, BMI 18.2～26.4 kg/m2, ASA Ⅲ或Ⅳ级。采用随机数字表法分为两组：腹横平面阻滞组(TAP组)和局部浸润麻醉组(LAI组)。TAP 组: 于腹内斜肌和腹横肌间隙注入0.4%罗哌卡因30 ml。LAI组: 于切口位置皮下和皮下组织、腹外斜肌腱膜深部、耻骨结节上、腹股沟管、腹横筋膜与腹膜之间、疝囊与精索间分别注射0.4%罗哌卡因10、5、3、5、2、5 ml。记录切皮时(T1), 打开腹外斜肌腱膜时(T2), 游离疝囊时(T3), 分离腹膜前间隙、置入补片时(T4), 缝合腹横筋膜时(T5), 缝合腹外斜肌筋膜(T6), 皮肤切口闭合时(T7)VAS评分;记录术后即刻、术后12 h和24 h 静息和咳嗽时VAS评分;记录术中追加的舒芬太尼总量、手术时间、麻醉费用、术后恢复活动时间, 住院时间、患者对麻醉的满意度和术后4周神经损伤、腹腔脏器出血、腹膜穿孔、注射部位血肿或感染等并发症。

结果 T2-T7时TAP组VAS评分明显低于LAI组(P<0.05)。术后即刻和术后12 h TAP组静息和咳嗽时VAS评分均明显低于LAI组(P<0.05)。与LAI组比较, TAP组补救追加的舒芬太尼总量明显减少, 麻醉费用明显升高, 手术时间、术后恢复活动时间明显缩短, 满意度评分明显升高 (P<0.05)。两组住院时间和术后并发症差异无统计学意义。

结论 腹横平面阻滞作为主要的麻醉方式应用于老年高危患者的腹股沟疝修补术相较于局部浸润麻醉更加实用有效。
英文摘要:
      
Objective To discuss the safety and efficacy of transversus abdominis plane nerve block as the anesthesia method in the treatment of inguinal hernia.

Methods Forty patients undergoing inguinal hernia repair were selected, including 35 males and 5 females, aged 70-83 years old, BMI 18.2-26.4 kg/m2, ASA physical status Ⅲ or Ⅳ. They were divided into two groups by randomized digital table: group TAP with transversus abdominis plane block, and group LAI with local anesthesia. 0.4% Ropivacaine 30 ml was injected in the gap between abdominal obliques and transversus abdominis in group TAP; 0.4% ropivacaine 10 ml, 5 ml, 3 ml, 5 ml, 2 ml, 5 ml were respectively injected into subcutaneous tissue of incision site, external obliques, deep decidua, pubic tuberosity, inguinal, transverse fascia and peritoneum, between the hernia sac and spermatic cord in group LAI. VAS scores were recorded at cutting skin (T1), opening the external oblique aponeurosis (T2), freeing hernial sac (T3), separating the preperitoneal space, inserting the patch (T4), suturing the transverse fascia (T5), suturing the external oblique muscular fascia (T6), closing skin incision (T7). The VAS scores at rest and cough were recorded immediately after surgery, 12 h and 24 h after surgery, The quantity of introperative supplemental sufentanil, operating time, the anesthesia cost, postoperative recovery time, hospitalization days, patient′s satisfaction with anesthesia, and anesthesia complications (nerve injury, abdominal viscera hemorrhage, peritoneal perforation, injection site hematoma or infection) after 4 weeks of the operation were all recorded.

Results The VAS scores of 6 time points (T2-T7) in the group TAP were all lower than that in group LAI (P < 0.05). VAS scores of group TAP at rest and cough were significantly lower than group LAI immediately after surgery and 12 hours after surgery (P < 0.05). Compared with group LAI, the consumption of sufentanil was lower, the anesthesia cost was higher and the operating time and the postoperative recovery time were shorter, the degree of satisfaction in patients increased significantly in the group TAP (P< 0.05). There was no statistical difference in length of hospital stay and postoperative anesthesia complications between the two groups.

Conclusion The transversus abdominis plane nerve block as the main method of anesthesia is safer and more effective than local anesthesia in the treatment of inguinal hernia repair in elderly patients with high risk.
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