[1]齐金莲,王文华,何秋娟,等.肋间神经阻滞联合喉罩全身麻醉在小儿先天性心脏病介入封堵术中的应用效果[J].新乡医学院学报,2023,40(9):846-850.[doi:10.7683/xxyxyxb.2023.09.008]
　QI Jinlian,WANG Wenhua,HE Qiujuan,et al.Application effect of intercostal nerve block combined with laryngeal mask general anesthesia in interventional closure in children with congenital heart disease[J].Journal of Xinxiang Medical University,2023,40(9):846-850.[doi:10.7683/xxyxyxb.2023.09.008]
点击复制

肋间神经阻滞联合喉罩全身麻醉在小儿先天性心脏病介入封堵术中的应用效果
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
40卷
期数:
2023年9
页码:
846-850
栏目:
临床研究
出版日期:
2023-09-05

文章信息/Info

Title:
Application effect of intercostal nerve block combined with laryngeal mask general anesthesia in interventional closure in children with congenital heart disease
作者:
齐金莲; 王文华; 何秋娟; 陈夜茜; 周锐; 李郑琛; 贾英萍
（郑州大学附属儿童医院/河南省儿童医院/郑州儿童医院麻醉科，河南　郑州　450018）
Author(s):
QI Jinlian; WANG Wenhua; HE Qiujuan; CHEN Yexi; ZHOU Rui; LI Zhengchen; JIA Yingping
(Department of Anesthesiology,Children′s Hospital Affiliated to Zhengzhou University / Henan Children′s Hospital / Zhengzhou Children′s Hospital,Zhengzhou 450018,Henan Province,China)
关键词:
先天性心脏病; 肋间神经阻滞; 喉罩; 介入封堵术
Keywords:
congenital heart defect; intercostal nerve block; laryngeal mask; interventional closure surgery
分类号:
R722.19
DOI:
10.7683/xxyxyxb.2023.09.008
文献标志码:
A
摘要:
目的　探讨肋间神经阻滞（ICNB）联合喉罩全身麻醉在小儿先天性心脏病介入封堵术中的应用效果与安全性。
方法　选择2022年1月至2022年10月河南省儿童医院收治的112例先天性心脏病患儿为研究对象，所有患儿行介入封堵术，根据麻醉方法将患儿分为观察组和对照组。观察组患儿给予ICNB联合喉罩全身麻醉，对照组患儿给予气管插管全身麻醉。记录2组患儿的麻醉时间、手术时间、瑞芬太尼用量、麻醉后复苏室（PACU）停留时间、拔出喉罩或气管导管时间、不良反应及麻醉诱导前（T0）、插入喉罩或气管导管后即刻（T1）、切皮时（T2）、置入封堵器即刻（T3）、气管导管或喉罩去除即刻（T4）、苏醒即刻（T5）的心率（HR）和平均动脉压（MAP）。术后1、4、8、12、24 h，采用Wong-baker脸谱或FLACC评分法评估患儿的疼痛程度。
结果　T0、T5时，2组患儿的MAP、HR比较差异无统计学意义（P>0.05）；T1、T2、T3、T4时，观察组患儿的MAP、HR均显著低于对照组（P<0.05）；术后1～24 h，2组患儿疼痛评分均呈升高趋势（P<0.05）；术后1、4 h时，2组患儿的疼痛评分比较差异无统计学意义（P>0.05）；术后8、16、24 h时，观察组患儿的疼痛评分均显著低于对照组（P<0.05）。2组患儿的手术时间、麻醉时间比较差异无统计学意义（P>0.05）；观察组患儿瑞芬太尼用量显著少于对照组，PACU停留时间、拔出喉罩或气管导管时间显著短于对照组（P<0.05）。观察组患儿苏醒期躁动、咽喉痛、呛咳、恶心呕吐的发生率显著低于对照组（χ2=4.940、4.264、10.500,P<0.05）。
结论　ICNB联合喉罩全身麻醉用于先天性心脏病介入封堵术可维持患儿血流动力学稳定，且镇痛效果好、并发症少。
Abstract:
Objective　To investigate the application effect and safety of intercostal nerve block combined with laryngeal mask general anesthesia in interventional closure of congenital heart disease in children.
Methods　A total of 112 children with congenital heart disease admitted to Henan Children′s Hospital from January 2022 to October 2022 were selected as the research subjects.All children underwent interventional closure and were divided into observation group and control group according to the anesthesia method.The children in the observation group received intercostal nerve block (ICNB) and general anesthesia of laryngeal mask airway,and the children in the control group were given general anesthesia of tracheal intubation.The anesthesia time,operation time,dosage of remifentanil,stay time in post-anesthesia care unit (PACU),removal time of laryngeal mask or endotracheal tube and adverse reactions of children were recorded.The heart rate (HR) and mean arterial pressure (MAP) of children were recorded before anesthesia induction (T0) and at once after insertion of laryngeal mask or tracheal tube (T1),skin incision (T2),occluder placement (T3),removal of tracheal tube or laryngeal mask (T4) and recovery (T5).At 1,4,8,12 and 24 hours after operation,the pain degree of the children was evaluated by Wong-baker faces or FLACC score.From 1 to 24 hours after surgery,the pain scores of children in the two groups showed an upward trend (P<0.05).There was no statistically significant difference in the pain score of children between the two groups at 1 and 4 hours after surgery (P>0.05).At 8,16 and 24 hours after surgery,the pain scores of children in the observation group were significantly lower than those in the control group (P<0.05).There was no statistically significant difference in the operation time and anesthesia time of children between the two groups (P>0.05).The dosage of remifentanil in the observation group was significantly lower than that in the control group,and the retention time in PACU and the removal time of laryngeal mask or tracheal catheter were significantly shorter than those in the control group (P<0.05).The incidences of restlessness,sore throat,cough,nausea and vomiting of children in the observation group were significantly lower than those in the control group (χ2=4.940,4.264,10.500;P<0.05).
Conclusion　ICNB combined with laryngeal mask general anesthesia for interventional closure of children with congenital heart defect can maintain the stability of hemodynamics,and has good analgesic effect and fewer complications.

参考文献/References:

［1］　GAO Z,YU J,ZHANG Z W,et al.Perimembranous ventricular septal defect closure via ultra-minimal trans intercostal incision in children［J］．J Card Surg,2021,36(9):3131-3137.
［2］　DONTUKURTHY S,MOFIDI R． The Role of interfascial plane blocks in paediatric regional anaesthesia:a narrative review of current perspectives and updates［J］．Anesthesiol Res Pract,2020,2020:8892537.
［3］　WEBB　N,KARS M S,BUTLER A L,et al.The use of laryngeal mask airway for tonsillectomy and adenoidectomy［J］．Int J Pediatr Otorhinolaryngol,2021,144:110691.
［4］　中国医师协会儿科医师分会先天性心脏病专家委员会，中华医学会儿科分会心血管学组，《中华儿科杂志》编辑委员会.儿童常见先天性心脏病介入治疗专家共识［J］.中华儿科杂志，2015，53（1）：17-24.
CONGENITAL HEART DEFECT EXPERT COMMITTEE OF PEDIATRIC BRANCH OF CHINESE MEDICAL DOCTOR ASSOCIATION,CARDIOVASCULAR GROUP OF PEDIATRIC BRANCH OF CHINESE MEDICAL ASSOCIATION,EDITORIAL COMMITTEE OF CHINESE JOURNAL OF PEDIATRICS.Expert consensus on interventional treatment of common congenital heart defect in children［J］.Chin J Pediatr,2015,53(1):(5):17-24.
［5］　BHUSHAN D,NANDKUMAR S,BUTANI M.The comparison between supreme laryngeal mask airway and endotracheal tube with respect to adequacy of ventilation in patients undergoing laparoscopic cholecystectomy under general anesthesia:a prospective,randomized， double-blind study,and comparative study［J］.Asian J Anesthesiol,2022,60(1):11-18.
［6］　OBSA M S,SHOLLA A L,BARAKI B G,et al.Effect of laryngeal mask air way insertion versus endotracheal intubation over hemodynamic responses in pediatrics patient who underwent ophthalmic surgery at menelik Ⅱ hospital,addis ababa:a prospective observational study design［J］．Anesthesiol Res Pract， 2020，2020：7021641.
［7］　GONDAR M B,FERNANDES M,MONDRAGON P,et al.Intercostal nerve block is effective in open biopsies of the anterior mediastinal region:case report and review［J］．Int J Surg Case Rep,2022,97:107461.
［8］　SUZUKI K,SASAKI T,MIYAGI Y,et al.The effect of continuous field block through intercostal muscles after atrial septal defect closure via a mini-right thoracotomy in pediatric patients［J］.J Nippon Med Sch,2021,88(4):347-353.
［9］　傅海青，岑盛华，梁磊.肋间神经阻滞复合全身麻醉对胸腔镜手术患者血流动力学的影响［J］.中国内镜杂志，2018，24（1）：70-74.
FU H Q,CEN S H,LIANG L.Effect of intercostal nerve block combined with general anesthesia on hemodynamics in patients undergoing video-assisted thoracoscopic surgery［J］．Chin J Endosc,2018,24(1):70-74.
［10］　LUKOSIENE L,MACAS A,TREPENAITIS D,et al.Single shot intercostal block for pain management in pediatric patients undergoing the Nuss procedure:a double-blind,randomized,controlled study［J］．J Pediatr Surg,2014,49(12):1753-1757.
［11］　ALTUN D,DOGAN A,ARNAZ A,et al.Atrial septal defect closure via mini-thoracotomy in pediatric patients:postoperative analgesic effect of intercostal nerve block［J］．Turk Gogus Kalp Damar Cerrahisi Derg,2020,28(2):257-263.
［12］　URITS I,OSTLING P S,NOVITCH M B,et al.Truncal regional nerve blocks in clinical anesthesia practice［J］.Best Pract Res Clin Anaesthesiol,2019,33(4):559-571.
［13］　ZHONG H Y,DENG X B,WANG Z.Effects of fascia iliaca compartment block combined with general laryngeal mask airway anesthesia in children undergoing femoral fracture surgery:a randomized trial［J］．J Pain Res,2018,11:2821-2826.
［14］　MENNA C,FIORELLI S,MASSULLO D,et al.Laryngeal mask versus endotracheal tube for airway management in tracheal surgery:a case-control matching analysis and review of the current literature［J］．Interact Cardiovasc Thorac Surg,2021,33(3):426-433.
［15］　MA B J,SUN Y,HAO C,et al.Patient-controlled intravenous analgesia with or without ultrasound-guided bilateral intercostal nerve blocks in children undergoing the nuss procedure:a randomized,double-blinded，controlled trial［J］．Pain Res Manag,2022,2022:5776833.
［16］　JOHN W,DIFIOR E,JASON O,et al.Next day discharge after the Nuss procedure using intercostal nerve cryoablation,intercostal nerve blocks,and a perioperative ERAS pain protocol［J］．J Pediatr Surg,2022,57(2):213-218.

相似文献/References:

[1]马海燕,杨玉海,孙绍连,等.先天性心脏病单心室一例[J].新乡医学院学报,1993,10(01):026.
[2]乔　刚,胡建国,吴忠仕,等.Glenn 分流术治疗先天性心脏病50 例[J].新乡医学院学报,2006,23(06):611.
[3]朱耀斌,范祥明,李晓锋,等.改良肺动脉灌注在发绀型先天性心脏病体外循环术中的应用 [J].新乡医学院学报,2012,29(10):762.
[4]周子凡１,万居易２,李殿坤１,等. 老年先天性心脏病并发重度肺动脉高压外科手术治疗与保守治疗临床效果比较[J].新乡医学院学报,2015,32(08):774.
[5]张新科,李保林.不同浓度七氟烷全程吸入对行先天性心脏病矫治术患儿心肌的影响[J].新乡医学院学报,2019,36(7):629.[doi:10.7683/xxyxyxb.2019.07.007]
　ZHANG Xin-ke,LI Bao-lin.Effect of different concentrations of sevoflurane inhalation on myocardial of children underwent congenital heart disease rectification operation[J].Journal of Xinxiang Medical University,2019,36(9):629.[doi:10.7683/xxyxyxb.2019.07.007]
[6]王志斌,樊开凯,乔晨晖.血浆白细胞介素-18、硫化氢水平对先天性心脏病患儿术后并发急性肺损伤的诊断价值[J].新乡医学院学报,2021,38(4):353.[doi:10.7683/xxyxyxb.2021.04.012]
　WANG Zhibin,FAN Kaikai,QIAO Chenhui.Diagnostic value of plasma interleukin-18 and hydrogen sulfide levels for postoperative acute lung injury in children with congenital heart disease[J].Journal of Xinxiang Medical University,2021,38(9):353.[doi:10.7683/xxyxyxb.2021.04.012]
[7]王鹏高,崔亚洲,陈忠建,等.大动脉调转术治疗婴儿大动脉转位近期疗效观察[J].新乡医学院学报,2020,37(8):729.[doi:10.7683/xxyxyxb.2020.08.006]
　WANG Penggao,CUI Yazhou,CHEN Zhongjian,et al.Short-term effect of arterial switch operation in the treatment of transposition of great arteries in infants[J].Journal of Xinxiang Medical University,2020,37(9):729.[doi:10.7683/xxyxyxb.2020.08.006]
[8]熊言顺,疏树华,王　迪,等.肋间神经阻滞联合羟考酮用于单孔胸腔镜肺癌根治术后多模式镇痛效果观察[J].新乡医学院学报,2020,37(10):935.[doi:10.7683/xxyxyxb.2020.10.008]
　XIONG Yanshun,SHU Shuhua,WANG Di,et al.Multimodal analgesic effect of intercostal nerve blocking combined with oxycodone in lung cancer patients after uniportal video-assisted thoracoscopic radical resection of lung cancer[J].Journal of Xinxiang Medical University,2020,37(9):935.[doi:10.7683/xxyxyxb.2020.10.008]
[9]潘　晔.先天性心脏病的发病特点及影响因素分析[J].新乡医学院学报,2019,36(3):281.[doi:10.7683/xxyxyxb.2019.03.019]
　PAN Ye.Analysis of the characteristics and influencing factors of congenital heart disease[J].Journal of Xinxiang Medical University,2019,36(9):281.[doi:10.7683/xxyxyxb.2019.03.019]
[10]王鹏高,张军喜,蒋丽芳,等.先天性室间隔缺损危险因素分析[J].新乡医学院学报,2018,35(12):1064.[doi:10.7683/xxyxyxb.2018.12.005]
　WANG Peng-gao,ZHANG Jun-xi,JIANG Li-fang,et al.Analysis of the risk factors for congenital ventricular septal defect[J].Journal of Xinxiang Medical University,2018,35(9):1064.[doi:10.7683/xxyxyxb.2018.12.005]

更新日期/Last Update: 2023-09-05