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目的:探讨超声引导腹横肌平面阻滞对腹股沟斜疝手术患儿七氟醚复合麻醉恢复期躁动的影响。方法:择期行腹股沟斜疝手术患儿120例,年龄2~7岁,性别不限,体重10~30 kg,ASAⅠ级。采用随机数字表法,将其分为对照组(Ⅰ组)和腹横肌平面阻滞组(Ⅱ组),每组60例。麻醉诱导后置入喉罩,行机械通气。麻醉维持:吸入七氟醚,呼气末浓度为0.6%~1.7%,必要时间断静脉注射芬太尼0.5~1.0μg·kg~(-1)。麻醉诱导后Ⅱ组采用超声辅助定位实施患侧腹横肌平面阻滞,局麻药为0.2%罗哌卡因2 mg·kg~(-1),Ⅰ组注入等量生理盐水。记录手术时间、喉罩拔除时间和苏醒时间,于复苏室期间进行躁动评分,记录术后躁动发生情况,术后疼痛评分采用改良面部表情评分法(FLACC),记录麻醉恢复期低氧血症(Sp O_2<90%持续10 s)和恶心呕吐等不良反应的发生情况。结果:与Ⅰ组比较,Ⅱ组术中芬太尼用量和平均呼气末七氟醚浓度降低,喉罩拔除时间和苏醒时间缩短,躁动发生率和FLACC评分降低(P<0.01或0.05)。结论:超声引导腹横肌平面阻滞有助于降低腹股沟斜疝手术患儿七氟醚复合麻醉恢复期躁动的发生。
Objective: To investigate the effect of ultrasound-guided transverse block on the agitation of sevoflurane anesthesia in children with inguinal hernia. Methods: A total of 120 children with inguinal hernia undergoing elective surgery, aged 2 to 7 years old, with no gender, weighing 10-30 kg, ASA grade Ⅰ. Using random number table method, divided into control group (Ⅰ group) and transverse abdominal plane block group (Ⅱ group), 60 cases in each group. After induction of anesthesia into the laryngeal mask, mechanical ventilation. Anesthesia maintenance: sevoflurane inhalation, end-expiration concentration of 0.6% to 1.7%, the necessary time to intravenous injection of fentanyl 0.5 ~ 1.0μg · kg ~ (-1). After induction of anesthesia, the patients in group Ⅱ received ultrasonic assisted positioning for plaque block of the contralateral transverse abdominal muscle. The local anesthetic was 0.2% ropivacaine 2 mg · kg -1, and the same group of normal saline was injected into group Ⅰ. The operation time, laryngeal mask removal time and recovery time were recorded. The restlessness was recorded during the recovery room. Postoperative agitation was recorded. Postoperative pain score was assessed by modified facial expression score (FLACC) Sp O_2 <90% for 10 s) and nausea and vomiting and other adverse reactions. Results: Compared with group Ⅰ, the intraoperative fentanyl dosage and average end-tidal sevoflurane concentration decreased, the laryngeal mask removal time and recovery time shortened, and the incidence of agitation and FLACC decreased (P <0.01 or 0.05). CONCLUSIONS: Ultrasound-guided horizontal block of abdominal transverse muscle helps to reduce the occurrence of restless agitation in sevoflurane anesthesia in children with inguinal hernia.