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

摘要: 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。

Abstract: 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.