【摘要】 目的探讨超声引导下局部神经阻滞在老年腹股沟疝患者无张力修补术中的应用。方法回顾性分析2014年6月至2016年6月聊城市人民医院收治的64例老年单侧男性腹股沟疝患者,采用超声引导下局部神经阻滞+局部浸润麻醉29例(超声引导组),对比同期体表定位局部神经阻滞+局部浸润麻醉35例(体表定位组),观察两组患者手术过程中麻醉效果、局麻药用量、手术时间、术后疼痛情况及镇痛持续时间、并发症发生率及随访复发率。结果所有患者均为60岁以上男性,年龄(67.5±5.3)岁。两组患者手术过程中手术区肌肉松弛,无明显疼痛感,均顺利完成手术。超声引导组术中局麻药用量为(24.3±4.2)ml,体表定位组为(24.8±3.7)ml,两组比较差异无统计学意义(t=0.491,P=0.625)。超声引导组手术时间为(55.2±10.0)min,体表定位组为(49.3±10.7)min,两组比较差异有统计学意义(t=2.267,P=0.027)。术后1、2 h超声引导组VAS评分(2.3±0.8)分、(1.5±1.0)分,体表定位组分别为(2.6±1.0)分、(1.2±1.1)分,两者比较差异均无统计学意义(t=-1.281、0.728,P=0.205、0.470);术后6 h超声引导组VAS评分为(0.4±0.5)分,显著低于体表定位组的(1.2±0.9)分,差异有统计学意义(t=0.000,P<0.05)。两组患者麻醉满意度评分差异无统计学意义。平均随访(33.5±6.5)个月,无复发、慢性疼痛等术后并发症发生。结论超声引导下局部神经阻滞可获得满意的麻醉效果,与体表定位下局部神经阻滞相比,手术时间稍长,但并不增加局麻药的用量,可延长术后镇痛时间,是老年腹股沟疝患者的理想麻醉方式,前景广阔,有待进一步推广。更多还原

【Abstract】 Objective To evaluate the application of ultrasound-guided nerve block in elderly patients undergoing inguinal hernia surgery. Methods A retrospective analysis was carried out of sixty-four elderly male patients who had underwent unilateral inguinal hernia repair under local nerve block anesthesia from June 2014 to June 2016 in Liaocheng People’s Hospital. Twenty-nine patients undergoing ultrasoundguided nerve block were the ultrasound-guided group, meanwhile the 35 cases undergoing anatomia located nerve block were the anatomia located group. Clinical data including anesthesia effects, anesthesia dosage,operation time, pain scores, postoperative complications and recurrence rates were recorded and analyzed.Results All the patients aged over 60 years old, with an average age of(67.5±5.3) years. All operations were completed successfully. The average anesthesia dosage of ultrasound-guided group was(24.3±4.2) ml and(24.8±3.7) ml in the anatomia located group, with no significant difference(t=0.491, P=0.625). The average operation time of two groups was(55.2±10.0) min vs(49.3±10.7) min with significant difference(t=2.267, P=0.027). One hour after surgery, the VAS score of the ultrasound-guided group was(2.3±0.8),and two hours after surgery the score was(1.5±1.0), meanwhile the scores of the anatomia located group respectively were(2.6±1.0) and(1.2±1.1), with no statistical significances(t=-1.281, 0.728, P=0.205,0.470). Six hours after surgery, the VAS scores were(0.4±0.5) vs(1.2±0.9), with statistical significance(t=0.000, P<0.05). There was no difference in anesthesia satisfaction scores between the two groups. No significant postoperative complications were observed in the two groups, with an average folow-up of(33.5±6.5) months, no recurrence or chronic pain occurred. Conclusions Local nerve block guided by ultrasound shows satisfactory anesthetic effects. Compared with local nerve block under body surface localization, it slightly increases operation time, but does not increase the dosage of local anesthetics, which can extend the postoperative analgesia time. Local nerve block guided by ultrasound is an ideal anesthesia in elderly patients with inguinal hernia and needs to be further promoted.更多还原