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目的 观察3种不同入路腹横肌平面阻滞(TAP)用于小儿下腹部手术术后镇痛效果的差异.方法 选择2014年1月至12月福建中医药大学附属人民医院在全麻行下腹部手术患儿90例,年龄1～6岁,随机分为3组,每组30例.在全身麻醉后肋缘下组行肋缘下TAP,侧路组行侧路TAP,后路组行后路TAP.记录术后4、8、12、16、24 h时东安大略儿童医院疼痛评分(CHEOPS)、Ramsay镇静评分与术后4h时镇痛平面,并观察有无恶心、呕吐、皮肤瘙痒、尿潴留、下肢活动障碍、呼吸抑制等并发症.结果 与术后4h比较,肋缘下组术后12h时、侧路组术后16h时、后路组术后24 h时CHEOPS评分开始升高,Ramsay评分开始下降(P＜0.05);与肋缘下组的镇痛平面比较,侧路组、后路组的镇痛平面较小(P＜0.05).对3组患儿恶心、呕吐、尿潴留、嗜睡、呼吸抑制等并发症进行两两比较差异无统计学意义(P＞0.05);与后路组比较,肋缘下组、侧路组下肢肌力下降发生率较低(P＜0.05).结论 3种腹横肌平面阻滞均可有效缓解小儿下腹部手术后8h内的疼痛,肋缘下TAP镇痛时间较短,后路TAP有一定的下肢肌力下降,侧路法TAP最适合于小儿下腹部手术后镇痛的需要.

Objective To observe the different effect of transversus abdominis plane block (TAP) with three approaches for postoperative analgesia in pediatric lower abdominal surgery.Methods Ninety children with lower abdominal operation from People's Hospital Affiliated to Fujian Chinese Traditional Medicine University from January 2014 to December,aged 1-6 years old,were randomly divided into 3 groups with 30 cases in each:TAP beneath the rib edge in subcostal approach group,TAP from lateral abdomen wall in lateral approach group,and TAP from posterior wall in posterior approach group.The Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and Ramsay sedation score were used to evaluate the analgesic and sedative effect.Analgesic plane,CHEOPS and Ramsay score were recorded at 4 h,8 h,12 h,16 h and 24 h postoperatively.Nausea,vomit,skin itch,urinary retention,lower limb movement disorder,respiratory depression and other complications were observed and recorded.Results Compared with postoperative 4 h,CHEOPS increased in the subcostal approach group at 12 h after the operation,and increased in the lateral approach group at 16 h and the posterior approach group at 24 h,and Ramsay score decreased at the same time (P＜0.05).The analgesic plane in the subcostal approach group was broader than that in the lateral approach group and the posterior approach group (P＜0.05).The differences of nausea,vomit,urinary retention,lethargy,respiratory depression and other complications in the three groups were not statistically (P＞0.05).The incidence of lower limb movement disorder in the subcostal approach group and the lateral approach group was lower compared with the posterior approach group (P＜0.05).Conclusion Transversus abdominis plane block with three approaches can all relief the pain effectively in pediatric lower abdominal surgery within 8 h after operation,the effective analgesic time of subcostal approach TAP is shorter than others,and muscle strength of lower limbs is decreased in the posterior approach TAP.Lateral approach of TAP is the most suitable one for analgesic requirement after lower abdominal surgery in children.