目的 对比研究髂腹股沟神经髂腹下神经阻滞及腰硬联合麻醉在老年腹股沟斜疝患者手术中的应用。方法 选择行腹股沟斜疝疝囊高位结扎修补术老年患者60例,均为男性,美国麻醉医师协会(ASA)Ⅱ~Ⅲ级,均为男性。随机将患者分成神经阻滞组与腰硬联合组,每组30例,分别记录入室时、切皮前、切皮后15 min、术毕的心率 (heart rate,HR)、平均动脉压(mean arterial pressure,MAP)、血氧饱和度(saturation of pulse O₂,SpO₂)变化,记录麻醉操作时间、术后恢复活动时间,麻醉效果评级及术后尿潴溜例数。结果 (1)两组各个时间的HR、MAP,SpO₂的比较,差异无统计学意义。(2)神经阻滞组操作时间为(3.0±0.8)min,术后恢复活动时间(3.5±1.0)h,而腰硬联合组分别为(14.8±1.0) min和(9.0±1.3)h ,两组比较,差异有统计学意义(P<0.05)。(3)麻醉效果评级: 神经阻滞组Ⅰ级28例,Ⅱ级2例,腰硬联合组分别为29例和1例,两组差异无统计学意义。(4)术后尿潴留情况:神经阻滞组有2例,腰硬联合组有12例,差异有统计学意义(P<0.05)。结论 老年患者行腹股沟斜疝疝囊高位结扎修补术,应用髂腹股沟神经髂腹下神经阻滞麻醉操作简单,术后恢复活动时间明显减少,麻醉并发症少,优于腰硬联合麻醉。

Objective To comparatively study the clinical efficacy of elderly indirect inguinal hernia opration under ilioinguinal-iliohypogastric nerve block and combined spinal-epidural anesthesia. Methods This study included sixty ASA Ⅱ-Ⅲ elderly male patients, undergoing high ligation of hernial sac and indirect inguinal hernia repair. The patients were randomly divided into two groups: group of ilioinguinal-iliohypogastric nerve block and group of combined spinal-epidural anesthesia. HR(heart rate), MAP(mean arterial pressure)and SpO₂ were measured at 4 time points, entering the operating room, before skin incision, 15 min after incision, and end of operation. Anesthesia proceeding time, average recovery time, anesthesia effect assessment and cases of urinary retention were recorded during and after operation. Results (1) HR, MAP, SpO₂ were not significantly different at each time point in both groups(P＞0.05). (2) Anesthesia proceeding time and average recovery time in the group of the nerve block were (3.0±0.8) min and (3.5±1.0)h respectively, in the group of combined spinal-epidural anesthesia were (14.8±1.0)min and(9.0±1.3)h respectively,with significant differences(P<0.05). (3) Anesthesia effect assessment: there were 28 cases of grade Ⅰand 2 cases of grade Ⅱ in the group of the nerve block , and 29 cases of grade Ⅰand 1 case of grade Ⅱ in the group of combined spinal-epidural anesthesia, there was no significant differences between the two groups. (4) Cases of urinary retention after operation in the group of nerve block (2 cases) was less than in the group of combined spinal-epidural anesthesia (12 cases)(P<0.05). Conclusions High ligation of hernial sac and indirect inguinal hernia repair for elderly patients under ilioinguinal-iliohypogastric nerve block is characterized by simplicity and safety, good effect, rapid recovery and less complication. It is better than combined spinal-epidural anesthesia.