超声引导下胸腰筋膜平面阻滞在脑瘫患儿选择性脊神经后根切断术中的应用

Application of ultrasound-guided thoracolumbar interfascial plane block in children with cerebral palsy undergoing selective posterior rhizotomy

中文关键词: 超声  胸腰筋膜平面阻滞  脑瘫  儿童  选择性脊神经后根切断术

英文关键词: Ultrasound  Thoracolumbar interfascial plane block  Cerebral palsy  Child  Selective posterior rhizotomy

中文摘要:

      
目的 探讨超声引导下胸腰筋膜平面（TLIP）阻滞在脑瘫患儿选择性脊神经后根切断术（SPR）中的应用效果。

方法 选择行SPR的脑瘫患儿56例，男31例，女25例，年龄6～12岁，体重18～47 kg，ASA Ⅰ或Ⅱ级。采用随机数字表法将患儿分为两组：超声引导下TLIP阻滞联合全麻组（T组）和单纯全麻组（C组），每组28例。所有患儿静脉全麻用药方案一致。T组插管翻身后行超声引导下双侧TLIP阻滞，0.2%罗哌卡因 0.5 ml/kg，最大用量小于20 ml，30 min后开始手术。C组不行阻滞。记录术中丙泊酚和瑞芬太尼用量，镇痛泵首次按压时间、术后24 h内镇痛泵总按压次数和有效按压次数，术后2、6、12、24 h静息和活动时VAS疼痛评分，术后住院时间、补救镇痛情况、患儿家属满意情况，皮肤瘙痒、低氧血症、恶心呕吐等不良反应发生情况。

结果 与C组比较，T组术中丙泊酚和瑞芬太尼用量均明显减少（P＜0.05），镇痛泵首次按压时间明显延长（P＜0.05），术后24 h内镇痛泵按压的总次数和有效按压次数明显减少（P＜0.05），术后2、6、12 h静息和活动时VAS疼痛评分明显降低（P＜0.05），术后住院时间明显缩短（P＜0.05），补救镇痛率明显降低（P＜0.05），患儿家属满意率明显升高（P＜0.05）。两组皮肤瘙痒、呼吸抑制、恶心呕吐等不良反应的发生率差异无统计学意义。

结论 超声引导下TLIP阻滞可为行SPR的脑瘫患儿提供较为完善的镇痛，减少全麻药用量，加速术后康复。

英文摘要:

      
Objective To investigate the effect of ultrasound-guided thoracolumbar interfascial plane (TLIP) block in children with cerebral palsy undergoing selective posterior rhizotomy (SPR).

Methods Fifty-six children with cerebral palsy undergoing SPR were selected, 31 males and 25 females, aged 6-12 years, weighing 18-47 kg, ASA physical status Ⅰ or Ⅱ, randomly divided into two groups: ultrasound-guided TLIP block combined with general anesthesia group (group T) and general anesthesia group (group C), 28 patients in each group. All the patients received the same general anesthesia regimen. In group T, ultrasound-guided bilateral TLIP block was performed and 0.2% ropivacaine 0.5 ml/kg was given in each side after intubation, the maximum dosage was less than 20 ml. After 30 minutes, the surgery was performed. Patients in group C did not undergo such treatment. The consumption of propofol and remifentanil during the procedure were recorded. The time of first analgesic pump press, the total pressing times and effective pressing times of analgesic pump within 24 hours after surgery were recorded. VAS scores at rest and movement were evaluated 2, 6, 12, and 24 hours after surgery. The hospitalization time after surgery, the occurrence of rescue analgesia, and the satisfaction of patients were recorded. Adverse reactions such as skin pruritus, hypoxemia, nausea and vomiting were recorded within 24 hours after operation.

Results Compared with group C, the consumption of propofol and remifentanil during the procedure were significantly lower in group T (P < 0.05), the time of first analgesic pump press was prolonged in group T (P < 0.05), the number of total pump compressions and effective pump compressions in group T were significantly decreased (P < 0.05), VAS scores 2, 6, and 12 hours after surgery were significantly lower in group T (P < 0.05), the hospitalization time in group T was significantly shortened (P < 0.05), the incidence of rescue analgesia in group T was significantly decreased (P < 0.05), the satisfaction of patients was significantly increased (P < 0.05). There were no significant differences in the incidences of skin pruritus, hypoxemia, nausea and vomiting between the two groups.

Conclusion Ultrasound-guided TLIP block can provide more perfect analgesia during the surgery and within 12 hours after surgery for children with cerebral palsy, meanwhile, it reduces the consumption of general anesthetics and brings about early recovery.