目的:探讨超声引导骶管阻滞联合全身麻醉对隐匿性阴茎手术患儿围术期血流动力学、疼痛反应、术后苏醒质量的影响。方法:选取日照市人民医院60例择期行隐匿性阴茎手术患儿,采用随机数字表法随机分为两组:全身麻醉组(C组)和超声引导骶管阻滞联合全身麻醉组(S组)。分别于入手术室麻醉前(T1),手术开始时(T2),手术结束时(T3)、喉罩拔除时(T4)四个时间点分别记录两组患儿平均血压(BP)、心率(HR)。记录两组患儿手术时长、瑞芬太尼用量及术中补液量。记录两组患儿的苏醒时间和PACU停留时间。分别于手术结束后2 h、6 h、12 h、24 h四个时间点利用FLACC疼痛评估量表评价两组患儿疼痛程度,如果FLACC > 3分,给予对乙酰氨基酚塞肛,记录两组患儿术后24 h对乙酰氨基酚的使用率。记录两组患儿麻醉苏醒期躁动发生率;记录两组患儿术后48 h内发生的不良反应(恶心呕吐、尿潴留)。结果:与C组患儿比较,S组患儿瑞芬太尼用量降低(P < 0.05);在T3、T4时间点,与C组患儿比较,S组患儿血压、心率均降低(P < 0.05);与C组患儿比较,S组患儿苏醒时间、PACU停留时间降低(P < 0.05);在手术结束后2 h、6 h、12 h时间点,与C组患儿比较,S组患儿FLACC疼痛评分降低(P < 0.05);与C组患儿比较,S组患儿术后24 h对乙酰氨基酚的使用率、麻醉苏醒期躁动发生率降低降低(P < 0.05);与C组患儿比较,S组患儿尿潴留发生率升高(P < 0.05)。结论:超声引导骶管阻滞联合全身麻醉可改善隐匿性阴茎手术患儿疼痛反应、提高苏醒质量。 To investigate the effects of ultrasound-guided sacral block combined with general anesthesia on perioperative hemodynamics, pain response and postoperative recovery in children with concealed penis surgery. Methods: 60 children undergoing concealed penile surgery in the People’s Hospital of Rizhao were selected and divided into two groups: general anesthesia group (group C) and ultrasound-guided sacral block combined with general anesthesia group (group S). The mean blood pressure (BP) and heart rate (HR) of the two groups were recorded at four time points: before anesthesia (T1), at the beginning of operation (T2), at the end of operation (T3) and at the time of laryngeal mask removal (T4). The operation time, remifentanil dosage and intraoperative fluid volume were recorded in the two groups. The recovery time and PACU stay time were recorded in the two groups. FLACC pain assessment scale was used to evaluate the pain degree of the children in the two groups at 2 h, 6 h, 12 h and 24 h after the end of the operation. If FLACC > 3 points, acetaminophen was given to the anus, and the use rate of acetaminophen in the two groups was recorded at 24 h after operation. The incidence of agitation during anesthesia recovery period was recorded in the two groups. The adverse reactions (nausea and vomiting, urinary retention) within 48 hours after operation were recorded in the two groups. Results: Compared with group C, the dosage of remifentanil in group S was decreased (P < 0.05). At T3 and T4 time points, compared with group C, the blood pressure and heart in group S decreased (P < 0.05). Compared with group C, the recovery time and the PACU stay time in group S decreased (P < 0.05). At 2 h, 6 h, and 12 h after the end of surgery, compared with group C, the FLACC pain score in group S decreased (P < 0.05). Compared with group C, the usage rate of acetaminophen and the incidence of agitation during anesthesia recovery in group S decreased (P < 0.05). Compared with group C, the incidence of urinary retention in group S was increased (P < 0.05). Conclusions: Ultrasound-guided sacral block combined with general anesthesia can improve the pain response and the quality of recovery in children undergoing concealed penile surgery.
目的:探讨超声引导骶管阻滞联合全身麻醉对隐匿性阴茎手术患儿围术期血流动力学、疼痛反应、术后苏醒质量的影响。方法:选取日照市人民医院60例择期行隐匿性阴茎手术患儿,采用随机数字表法随机分为两组:全身麻醉组(C组)和超声引导骶管阻滞联合全身麻醉组(S组)。分别于入手术室麻醉前(T1),手术开始时(T2),手术结束时(T3)、喉罩拔除时(T4)四个时间点分别记录两组患儿平均血压(BP)、心率(HR)。记录两组患儿手术时长、瑞芬太尼用量及术中补液量。记录两组患儿的苏醒时间和PACU停留时间。分别于手术结束后2 h、6 h、12 h、24 h四个时间点利用FLACC疼痛评估量表评价两组患儿疼痛程度,如果FLACC > 3分,给予对乙酰氨基酚塞肛,记录两组患儿术后24 h对乙酰氨基酚的使用率。记录两组患儿麻醉苏醒期躁动发生率;记录两组患儿术后48 h内发生的不良反应(恶心呕吐、尿潴留)。结果:与C组患儿比较,S组患儿瑞芬太尼用量降低(P < 0.05);在T3、T4时间点,与C组患儿比较,S组患儿血压、心率均降低(P < 0.05);与C组患儿比较,S组患儿苏醒时间、PACU停留时间降低(P < 0.05);在手术结束后2 h、6 h、12 h时间点,与C组患儿比较,S组患儿FLACC疼痛评分降低(P < 0.05);与C组患儿比较,S组患儿术后24 h对乙酰氨基酚的使用率、麻醉苏醒期躁动发生率降低降低(P < 0.05);与C组患儿比较,S组患儿尿潴留发生率升高(P < 0.05)。结论:超声引导骶管阻滞联合全身麻醉可改善隐匿性阴茎手术患儿疼痛反应、提高苏醒质量。
骶管阻滞,隐匿性阴茎手术,疼痛反应,术后苏醒
Ling Zhang1,2, Tao Zhao2, Xiaohan Xu2, Nianliang Zhang2, He Dong1*
1Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao Shandong
2Department of Anesthesiology, The people’s Hospital of Rizhao, Rizhao Shandong
Received: Feb. 21st, 2024; accepted: Apr. 2nd, 2024; published: Apr. 9th, 2024
To investigate the effects of ultrasound-guided sacral block combined with general anesthesia on perioperative hemodynamics, pain response and postoperative recovery in children with concealed penis surgery. Methods: 60 children undergoing concealed penile surgery in the People’s Hospital of Rizhao were selected and divided into two groups: general anesthesia group (group C) and ultrasound-guided sacral block combined with general anesthesia group (group S). The mean blood pressure (BP) and heart rate (HR) of the two groups were recorded at four time points: before anesthesia (T1), at the beginning of operation (T2), at the end of operation (T3) and at the time of laryngeal mask removal (T4). The operation time, remifentanil dosage and intraoperative fluid volume were recorded in the two groups. The recovery time and PACU stay time were recorded in the two groups. FLACC pain assessment scale was used to evaluate the pain degree of the children in the two groups at 2 h, 6 h, 12 h and 24 h after the end of the operation. If FLACC > 3 points, acetaminophen was given to the anus, and the use rate of acetaminophen in the two groups was recorded at 24 h after operation. The incidence of agitation during anesthesia recovery period was recorded in the two groups. The adverse reactions (nausea and vomiting, urinary retention) within 48 hours after operation were recorded in the two groups. Results: Compared with group C, the dosage of remifentanil in group S was decreased (P < 0.05). At T3 and T4 time points, compared with group C, the blood pressure and heart in group S decreased (P < 0.05). Compared with group C, the recovery time and the PACU stay time in group S decreased (P < 0.05). At 2 h, 6 h, and 12 h after the end of surgery, compared with group C, the FLACC pain score in group S decreased (P < 0.05). Compared with group C, the usage rate of acetaminophen and the incidence of agitation during anesthesia recovery in group S decreased (P < 0.05). Compared with group C, the incidence of urinary retention in group S was increased (P < 0.05). Conclusions: Ultrasound-guided sacral block combined with general anesthesia can improve the pain response and the quality of recovery in children undergoing concealed penile surgery.
Keywords:Sacral Canal Block, Concealed Penis Surgery, Pain Reaction, Postoperative Recovery
Copyright © 2024 by author(s) and beplay安卓登录
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小儿隐匿性阴茎因阴茎部位神经分布较为密集,术中和术后患儿会出现剧烈的疼痛,不利于术后患儿恢复 [
于2021年1月到2023年11月选取日照市人民医院择期日照市人民医院择期行隐匿性阴茎手术患儿60例,分为两组:全身麻醉组(C组,n = 30例)和超声引导骶管阻滞联合全身麻醉组(S组,n = 30例)。
纳入标准:年龄4岁~12岁,ASA分级I~II级;凝血功能未见明显异常;无局麻药过敏及神经系统疾病病史;穿刺部位皮肤无破损及感染病灶;骶尾部无畸形。
排除标准:对相关药物(罗哌卡因、舒芬太尼等)过敏患儿;骶管神经阻滞禁忌症患儿;有精神疾病史患儿;严重心、肺、肝、肾功能不全患儿。
两组患儿术前禁食8 h、禁轻饮2 h,患儿均带留置针进入手术室,进入手术室后均面罩吸氧,对两组患儿进行无创血压(BP)、心率(HR)、脉搏血氧饱和度(SpO2)、心电图、BIS监测。两组患儿全身麻醉诱导:顺序静脉推注咪达唑仑1~2 mg、舒芬太尼0.3~0.5 μg/kg、丙泊酚1~2 mg/kg、顺苯磺酸阿曲库铵0.2 mg/kg,给氧去氮3 min后,行喉罩置入,双肺听诊后固定喉罩,接呼气末二氧化碳监测和麻醉机,进行机械通气。全身麻醉维持:七氟烷吸入,丙泊酚、瑞芬太尼泵注维持至手术结束,根据BIS (45~60)值和血流动力学(BP, HR)调节麻醉药物的剂量 ,术中按需追加肌松药顺苯磺酸阿曲库铵。试验组(S组)患儿在超声引导下采用高频探头长轴平面内技术,从尾侧端进针,当针尖越过骶尾韧带位置时注射1~3 ml局部麻醉药罗哌卡因,观察罗哌卡因的扩散方向,确定在骶管内后将剩余的罗哌卡因注入骶管内,用量为1 ml/kg (罗哌卡因浓度为0.2%),封顶剂量为20 ml。
记录两组患儿一般情况,包括年龄、体质量指数、ASA分级、手术时长、术中补液量、术中瑞芬太尼用量。
分别于入手术室麻醉前(T1),手术开始时(T2),手术结束时(T3)、喉罩拔除时(T4)四个时间点分别记录两组患儿平均血压(BP)、心率(HR)。分别于手术结束后2 h、6 h、12 h、24 h四个时间点利用FLACC疼痛评估量表评价两组患儿疼痛程度,如果FLACC > 3分,给予对乙酰氨基酚塞肛,记录两组患儿术后24 h对乙酰氨基酚的使用率。记录两组患儿麻醉苏醒期躁动发生率;记录两组患儿术后48 h内发生的不良反应(恶心呕吐、尿潴留)。
采用SPSS 26.0统计学软件进行分析,所有计量资料均以均数±标准差表示,两组均数的比较采用成组t检验,两组不同时间均数的比较采用采用重复测量设计的方差分析,计数资料比较采用Pearson卡方检验,以P < 0.05为差异有统计学意义。
对C组和S组两组患儿的一般情况(年龄、体质量指数、ASA分级、手术时长、术中补液量)进行比较,两组患儿在年龄、体质量指数、ASA分级、手术时长、术中补液量差异无统计学意义(P > 0.05)。与C组患儿比较,S组患儿瑞芬太尼用量降低(P < 0.05)。见表1。
指标 | C组 | S组 | 统计值 | P值 |
---|---|---|---|---|
年龄(岁) | 9.10 ± 2.38 | 9.33 ± 1.83 | t = −0.426 | 0.672 |
体质量指数(BMI) | 21.55 ± 1.40 | 21.73 ± 1.60 | t = −0.462 | 0.645 |
ASA分级(I/II) | 21/9 | 20/10 | χ2= 0.077 | 0.781 |
手术时长(min) | 37.40 ± 8.07 | 37.97 ± 7.66 | t = −0.279 | 0.781 |
术中补液量(ml) | 203.00 ± 46.10 | 200.33 ± 46.79 | t = 0.222 | 0.825 |
瑞芬太尼用量(μg) | 183.33 ± 68.51 | 147.17 ± 36.55 | t = 2.551 | 0.013 |
表1. 两组患儿一般情况比较
重复测量设计方差分析两组患儿血压发现,时间点比较、交互作用差异有统计学意义(P < 0.05),组间比较差异无统计学意义(P > 0.05)。组间比较:在T1、T2时间点,两组患儿血压差异无统计学意义(P > 0.05);在T3、T4时间点,与C组患儿比较,S组患儿血压降低(P < 0.05)。重复测量设计方差分析两组患儿心率发现,时间点比较、时间与组别交互作用差异有统计学意义(P < 0.05),组间比较差异无统计学意义(P > 0.05)。组间比较:在T1、T2时间点,两组患儿心率差异无统计学意义(P > 0.05);在T3、T4时间点,与C组患儿比较,S组患儿心率降低(P < 0.05)。见表2。
指标 | 血压(mmHg) | 心率(次/min) | ||||||
---|---|---|---|---|---|---|---|---|
C组 | S组 | F值 | P值 | C组 | S组 | F值 | P值 | |
T1 | 73.23 ± 7.95 | 74.17 ± 8.40 | 0.195 | 0.660 | 96.43 ± 12.22 | 96.87 ± 11.77 | 0.020 | 0.889 |
T2 | 69.53 ± 7.38 | 70.03 ± 8.08 | 0.063 | 0.803 | 86.97 ± 8.65 | 87.37 ± 7.91 | 0.035 | 0.852 |
T3 | 75.73 ± 7.05 | 70.33 ± 6.53 | 9.478 | 0.003 | 92.23 ± 6.02 | 84.17 ± 6.88 | 23.379 | <0.001 |
T4 | 78.67 ± 6.18 | 73.43 ± 6.59 | 10.062 | 0.002 | 93.17 ± 4.41 | 85.37 ± 6.27 | 31.042 | <0.001 |
F时间,P时间 | 95.012, <0.001 | 74.031, <0.001 | ||||||
F组别,P组别 | 1.578, 0.214 | 3.552, 0.064 | ||||||
F交互,P交互 | 43.229, <0.001 | 23.214, <0.001 |
表2. 两组患儿血流动力学(血压、心率)比较
对两组患儿术后FLACC评分重复测量设计方差分析发现,时间点比较、组间比较、时间与组别交互作用差异有统计学意义(P < 0.05)。组间比较:在手术结束后2 h、6 h、12 h时间点,与C组患儿比较,S组患儿FLACC疼痛评分降低(P < 0.05);在手术结束后24 h时间点,两组患儿FLACC疼痛评分差异无统计学意义(P > 0.05)。见表3。
时间 | C组 | S组 | F值 | P值 |
---|---|---|---|---|
术后2 h | 2.20 ± 1.06 | 1.13 ± 0.76 | 18.241 | <0.001 |
术后6 h | 3.07 ± 0.74 | 1.93 ± 0.64 | 40.293 | <0.001 |
术后12 h | 2.77 ± 0.73 | 2.07 ± 0.94 | 10.339 | 0.002 |
术后24 h | 1.93 ± 0.69 | 1.90 ± 0.71 | 0.034 | 0.855 |
F时间,P时间 | 17.403, <0.001 | |||
F组别,P组别 | 6.921, <0.001 | |||
F交互,P交互 | 33.429, <0.001 |
表3. 两组患儿术后FLACC评分比较
对两组患儿麻醉苏醒期躁动发生情况和术后24 h对乙酰氨基酚的使用情况进行比较,与C组患儿比较,S组患儿麻醉苏醒期躁动发生率降低(P < 0.05),S组患儿术后24 h对乙酰氨基酚的使用率降低(P < 0.05)。见表4。
指标 | C组 | S组 | 统计值 | P值 |
---|---|---|---|---|
苏醒期躁动发生情况(是/否) | 16/14 | 6/24 | χ2= 7.177 | 0.007 |
术后24 h对乙酰氨基酚使用情况(是/否) | 12/18 | 4/26 | χ2= 5.455 | 0.020 |
表4. 两组患儿麻醉苏醒期躁动发生情况和术后24 h对乙酰氨基酚的使用情况比较
对两组患儿术后不良反应的发生率进行比较,两组患儿恶心、呕吐的发生率差异无统计学意义(P > 0.05);与C组患儿比较,S组患儿尿潴留发生率升高(P < 0.05)。见表5。
分组 | 恶心 | 呕吐 | 尿潴留 |
---|---|---|---|
C组 | 12 (40.00%) | 6 (20.00%) | 1 (3.33%) |
S组 | 10 (33.33%) | 4 (13.33%) | 7 (23.33%) |
χ2值 | 0.287 | 0.480 | 5.192 |
P值 | 0.592 | 0.488 | 0.023 |
表5. 两组患儿术后不良反应的发生率比较
隐匿性阴茎是小儿常见的泌尿外科先天畸形,由于小儿生理与心理的发育相对成人来说都存在较大差异,在面对隐匿性阴茎手术时总会畏惧并且哭闹,不能配合手术,多模式镇痛麻醉可以有效解决此问题 [
研究表明 [
多模式镇痛能够有效减缓隐匿性阴茎手术患儿疼痛情况,区域阻滞联合全身麻醉可有效减轻隐匿性阴茎手术患儿围术期疼痛反应 [
本研究发现,在手术结束后2 h、6 h、12 h三个时间点骶管阻滞联合喉罩全身麻醉患儿FLACC评分均降低,是由于罗哌卡因这种长效的局部麻醉药物应用所致。研究表明 [
研究表明 [
综上所述,超声引导骶管阻滞联合喉罩全身麻醉可减轻隐匿性阴茎手术患儿围术期疼痛反应,稳定围术期血流动力学,术后苏醒质量提高,对患儿的快速康复具有重要意义。
张 玲,赵 涛,徐晓涵,张念亮,董 河. 超声引导骶管阻滞在小儿隐匿性阴茎手术中的临床应用Clinical Application of Ultrasound-Guided Sacral Block in Pediatric Concealed Penis Surgery[J]. 外科, 2024, 13(02): 19-25. https://doi.org/10.12677/hjs.2024.132003
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