不同入路腹横肌平面阻滞在小儿下腹部手术术后镇痛的应用(1)
【摘要】 目的：观察三种不同入路的腹横肌平面阻滞(TAP)应用于小儿下腹部手术术后镇痛的效果。方法：选择90例下腹部手术的患儿，年龄1～6岁，按照随机数字表法将其分为L、C、H三组，每组30例。L组行全身麻醉+肋缘下TAP，C组行全身麻醉+侧路TAP，H组行全身麻醉+后路TAP。观察并记录术后2、6、12、24 h的CHEOPS疼痛评分、Ramesay评分，以及与术后镇痛相关的不良反应。结果：与术后2 h比较，L组的术后12、24 h及C、H组的术后24 h CHEOPS评分均升高(P<0.05)、Ramesay评分下降(P<0.05)；与L组术后12 h比较，C、H组术后12 h CHEOPS評分升高(P<0.05)、Ramesay评分下降(P<0.05)。与H组比较，L组、C组的下肢运动异常的发生率更低(P<0.05)。结论：三种腹横肌平面阻滞均可以有效地缓解小儿下腹部手术术后12 h内的疼痛，肋缘下入路TAP镇痛时间稍短，后路入路TAP有一定的下肢肌力下降。
【关键词】 腹横肌平面阻滞； 术后镇痛； 小儿； 不同入路
【Abstract】 Objective：To observe the effect of three different approaches of transversus abdominis plane(TAP) block in pediatric abdominal surgery postoperative analgesia.Method：A total of 90 children with abdominal operation，aged 1-6 years old，were divided into L，C and H groups according to random number table method，30 cases in each group.L group received general anesthesia + rib edge TAP，C group received general anesthesia + axillary midline TAP，H group received general anesthesia + posterior TAP.CHEOPS pain score，Ramesay score and postoperative analgesia related adverse reactions of three groups were observed and recorded after 2，4，8，12 h.
Result：Compared with postoperative 2 h，L group after 8，12 h and C group，H group after 12 h，CHEOPS scores were significantly increased(P<0.05)，Ramesay scores decreased(P<0.05).Compared with L group after 12 h，C group and H group after 12 h CHEOPS scores increased(P<0.05)，Ramesay scores decreased(P<0.05).Compared with H group，the lower limb motor abnormalities of L group and C group were lower(P<0.05).Conclusion：Three transversus abdominis plane block are effectively relieve pain of children after 12 h of lower abdominal surgery，analgesia time of rib edge TAP is shorter，posterior TAP decreases muscle strength of lower limbs.
【Key words】 Transversus abdominis plane block； Postoperative analgesia； Pedia； Different approaches
doi：10.3969/j.issn.1674-4985.2017.20.004
快速康复外科强调围术期采用区域神经阻滞以减少全身麻醉药物的使用及用量，实行多模式的术后镇痛[1]。小儿手术后对伤害性刺激的反应较成人幅度大，并伴有严重的情绪反应，而围术期抑制应激反应可以显著改善患儿预后[2]。近年来，腹横肌平面阻滞作为一项新的区域麻醉技术方法，常常被用于腹部手术的术后镇痛以减轻患者的术后疼痛。侧路法、后路法、肋缘下法是最经常被用到的腹横肌平面阻滞(TAP)方法，这些阻滞方法对小儿下腹部手术术后镇痛的效果未见报道。本研究拟在超声引导下于全身麻醉后对小儿实行不同入路TAP阻滞，并对其进行初步的临床研究，现报道如下。
1 资料与方法
1.1 一般资料 该研究已经伦理学委员会批准(SQ2014-004-01)，患者知情同意。选择2014年1-12月拟在全麻下行下腹部手术的患儿120例，其中腹股沟斜疝修补术52例，阑尾切除术42例，精索鞘膜积液手术26例，年龄1～6岁，ASA Ⅰ或Ⅱ级。排除标准：早产儿、先天性心肺疾病、凝血功能异常及局麻药过敏史者；选择无发热及咳嗽，腹部穿刺部位的皮肤无破损及感染的患者。按照随机数字表法将其分为L、C、H三组，每组30例，L组行全身麻醉+肋缘下TAP组，C组行全身麻醉+侧路TAP组，H组行全身麻醉+后路TAP组，三组年龄、性别等一般情况比较，差异均无统计学意义(P>0.05)，见表1。, 百拇医药(卢浩杰 王翔锋)
【关键词】 腹横肌平面阻滞； 术后镇痛； 小儿； 不同入路
【Abstract】 Objective：To observe the effect of three different approaches of transversus abdominis plane(TAP) block in pediatric abdominal surgery postoperative analgesia.Method：A total of 90 children with abdominal operation，aged 1-6 years old，were divided into L，C and H groups according to random number table method，30 cases in each group.L group received general anesthesia + rib edge TAP，C group received general anesthesia + axillary midline TAP，H group received general anesthesia + posterior TAP.CHEOPS pain score，Ramesay score and postoperative analgesia related adverse reactions of three groups were observed and recorded after 2，4，8，12 h.
Result：Compared with postoperative 2 h，L group after 8，12 h and C group，H group after 12 h，CHEOPS scores were significantly increased(P<0.05)，Ramesay scores decreased(P<0.05).Compared with L group after 12 h，C group and H group after 12 h CHEOPS scores increased(P<0.05)，Ramesay scores decreased(P<0.05).Compared with H group，the lower limb motor abnormalities of L group and C group were lower(P<0.05).Conclusion：Three transversus abdominis plane block are effectively relieve pain of children after 12 h of lower abdominal surgery，analgesia time of rib edge TAP is shorter，posterior TAP decreases muscle strength of lower limbs.
【Key words】 Transversus abdominis plane block； Postoperative analgesia； Pedia； Different approaches
doi：10.3969/j.issn.1674-4985.2017.20.004
快速康复外科强调围术期采用区域神经阻滞以减少全身麻醉药物的使用及用量，实行多模式的术后镇痛[1]。小儿手术后对伤害性刺激的反应较成人幅度大，并伴有严重的情绪反应，而围术期抑制应激反应可以显著改善患儿预后[2]。近年来，腹横肌平面阻滞作为一项新的区域麻醉技术方法，常常被用于腹部手术的术后镇痛以减轻患者的术后疼痛。侧路法、后路法、肋缘下法是最经常被用到的腹横肌平面阻滞(TAP)方法，这些阻滞方法对小儿下腹部手术术后镇痛的效果未见报道。本研究拟在超声引导下于全身麻醉后对小儿实行不同入路TAP阻滞，并对其进行初步的临床研究，现报道如下。
1 资料与方法
1.1 一般资料 该研究已经伦理学委员会批准(SQ2014-004-01)，患者知情同意。选择2014年1-12月拟在全麻下行下腹部手术的患儿120例，其中腹股沟斜疝修补术52例，阑尾切除术42例，精索鞘膜积液手术26例，年龄1～6岁，ASA Ⅰ或Ⅱ级。排除标准：早产儿、先天性心肺疾病、凝血功能异常及局麻药过敏史者；选择无发热及咳嗽，腹部穿刺部位的皮肤无破损及感染的患者。按照随机数字表法将其分为L、C、H三组，每组30例，L组行全身麻醉+肋缘下TAP组，C组行全身麻醉+侧路TAP组，H组行全身麻醉+后路TAP组，三组年龄、性别等一般情况比较，差异均无统计学意义(P>0.05)，见表1。, 百拇医药(卢浩杰 王翔锋)