超声引导下行髂腹股沟及髂腹下神经阻滞麻醉在小儿腹腔镜腹股沟疝修补术中的应用

目的：探讨经超声引导行髂腹股沟及髂腹下神经阻滞麻醉在小儿腹腔镜腹股沟疝修补术中的临床效果，并与传统体表定位下的同样术式进行比较。方法选择行腹腔镜下腹股沟疝修补术的患儿64例，年龄7～13岁，随机分为两组，两组患儿均常规行喉罩通气全身麻醉。观察组患儿经超声引导行髂腹股沟及髂腹下神经阻滞麻醉，对照组患儿经传统体表定位后行相同神经阻滞。比较两组患儿术中心率（HR）、血压（ MAP）、脉搏氧饱和度（ SpO2）的变化以及手术持续时间、麻醉药物用量（全麻药、局麻药）和并发症发生情况，观察术毕患儿清醒时间、术后镇痛持续时间以及术后首次应用镇痛药时间。结果两组患儿均顺利完成手术。观察组局麻药总用量更低，为9．3±3．5mL，而对照组为13．6±5．2mL（t＝58．7，P＜0．05）。观察组术中舒芬太尼及异丙酚用量分别为7．5±3．8μg和140．7±14．4mg，而对照组分别为15．3±4．2μg和180．6±15．7mg；观察组的术后苏醒时间为7．2±1．5min，对照组为16．4±2．0min，两组比较有统计学意义（P＜0．05）。观察组患儿术后镇痛持续时间为225．0±36．0min，对照组为127．0±33．0min，两组比较有统计学意义（P＜0．05）。观察组不良反应显著低于对照组（P＜0．05）。结论在小儿腹腔镜疝修补术中经超声引导行髂腹股沟及髂腹下局部神经阻滞，可获得满意的麻醉效果，减少局部麻醉药用量和延长术后镇痛时间；术后并发症少，安全可行。

UItrasound guided iIioinguinaI and iIiohypogastric nerve bIock for chiIdren undergoing Iaparoscopic inguinaI hernia repair

OBJECTIVE To explore the clinical effect of ilioinguinal and iliohypogastric nerve block guided by ultrasound in patients of pediatric laparoscopic inguinal hernia repair .METHODS 64 cases of 7 ~13 years old children evaluated to accept with the laparoscopic inguinal hernia repair ,were randomLy divided into 2 groups,ac-cepted with routine LMA general anesthesia ,additionally the observe group adopted with the ilioinguinal and iliohypo-gastric nerve block guided by ultrasound , and the control group adopted with the traditional body positioning nerve block.Compare the 2 groups of children with ,HR,MAP,SpO2 ,the operation duration ,dosage of anesthetic ( general, nerve block anesthetics ) , complications , recovery time after operation , postoperative analgesia time and duration of analgesia for the first time.RESULTS The local anesthetics in the observe group (9.3 ±3.5 mL) was lower than the control group(13.6 ±5.2mL),(t=58.7,P<0.05).The dosages of sufentanyl and propofol was 7.5 ±3.8μg and 140.7 ±14.4 mg during operation in in the observation group ,but it was15.3 ±4.2μg and 180.6 ±15.7 mg in the control group ,the recovery time of postoperative in the obsere group was 7.2 ±1.5 min,16.4 ±2.0 min in the control group,the difference of above indexes in 2 groups was statistically significant (P<0.05).Duration of analge-sia was 225.0 ±36.0 min,127.0 ±33.0 min in control group ,the above indexes in the 2 groups had statistical signifi-cance difference ( P<0.05 ) .CONCLUSIONS Iliacgroin and iliac-hypogastric nerve block anesthesia guided by ultrasound in patients of pediatric laparoscopic inguinal hernia repair could obtain satisfactory anesthetic effect , re-duce the dosage of local anesthetics ,prolong analgesia time postoperative andmore lower complications postoperative .