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| 超声引导下腹横肌平面阻滞在新生儿下腹部手术中的应用 |
| Effect of the transverse abdominal plane block under ultrasound in the neonatal abdominal surgery |
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| DOI：10.12089/jca.2018.08.013 |
| 中文关键词: 腹横肌平面阻滞 超声 新生儿 |
| 英文关键词: Transverse abdominal plane block Ultrasound Neonate |
| 基金项目:陕西省重点研发计划(2017SF-022) |
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| 中文摘要: |
目的 观察超声引导下腹横肌平面(transversus abdominis plane, TAP)阻滞在新生儿下腹部手术中的麻醉效果。
方法 拟行下腹部手术的新生患儿30例,男19例,女11例,出生1～18 d,体重2.8～4 kg,ASA Ⅰ或Ⅱ级,按照随机数字表将患儿随机分为超声引导下TAP阻滞联合全身麻醉组(T组)和单纯全身麻醉组(G组),每组15例。T组患儿在超声引导下行双侧TAP阻滞,注入0.15%罗哌卡因0.5 ml/kg。两组均采用静-吸复合麻醉,吸入3%七氟醚,持续泵注瑞芬太尼0.1～0.3 μg·kg-1·min-1,维持BIS值在50～60。记录患儿术中阿片类药物用量;入室后、切皮时和拔管后30 min血浆皮质醇(Cor)浓度;苏醒时间,术后烦躁、呼吸抑制及需要补救镇痛情况。
结果 与G组比较,T组术中瑞芬太尼用量明显降低(P<0.05)。与入室后比较,切皮时和拔管后30 min,G组血浆Cor浓度明显升高(P<0.05);与G组比较,切皮时和拔管后30 min,T组血浆Cor浓度明显降低(P<0.05)。T组苏醒时间明显短于G组(P<0.05)。G组有4例(27%)需要补救镇痛,3例(20%)呼吸抑制及4例(27%)躁动,T组无一例不良反应。
结论 超声引导下0.15%罗哌卡因TAP阻滞可以安全有效地用于全麻下新生儿患下腹部手术。 |
| 英文摘要: |
Objective To investigate the effect of transverse abdominal plane (TAP) block under ultrasound in the neonatal abdominal surgery.
Methods Thirty neonate patients, 19 males and 11 females, aged 1 - 18 days, weighing 2.8 - 4 kg, ASA physical status Ⅰ or Ⅱ, were enrolled and divided into TAP block group (group T) and general anesthesia group (group G) by the randomized digital table. All the participants were anesthetized by inhaling 3% sevoflurane and remifentanil 0.1-0.3 μg·kg-1·min-1 and BIS was kept between 50-60. Two sides TAP block under ultrasound with 0.15% ropivacaine 0.5 ml/kg were used in group T. The dose of opioid used in operation was recorded. The blood Cor concentration was also recorded before anesthesia, at skin incision and 30 min after extubation. And the extubation time, the incidences of restlessness, respiratory depression, salvage analgesia were also recorded.
Results Compared with group G, the opioid dose of group T used in operations were significantly reduced (P < 0.05). Compared with before anesthesia, the COR concentration of group G at skin incision and 30 min after extubation rised significantly (P < 0.05). Compared with group G, COR concentration of group T at incision and at 30 min after extubation decreased significantly (P < 0.05). The extubation time of group G was also longer than group T (P < 0.05). In group G, 4 (27%) cases needed extra analgesia, 3 (20%) cases had respiratory inhibition and 4 (27%) had restlessness while group T had no adverse effect.
Conclusion The TAP block with 0.15% ropivacaine under ultrasound can be used safely and efficiently in the neonatal abdominal surgery. |
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