本文選題：腹股溝斜疝 + 骶管阻滯��； 參考：《蘭州大學(xué)》2014年碩士論文

【摘要】：目的許多研究評(píng)價(jià)了術(shù)前骶管阻滯對(duì)小兒腹股溝斜疝高位結(jié)扎術(shù)術(shù)后疼痛的影響,但是這些研究均未報(bào)告患兒術(shù)后身體恢復(fù)情況以及相關(guān)經(jīng)濟(jì)學(xué)指標(biāo)。本研究旨在采用歷史性隊(duì)列研究的方法,評(píng)價(jià)靜脈麻醉聯(lián)合骶管阻滯對(duì)腹股溝斜疝高位結(jié)扎術(shù)患兒術(shù)后恢復(fù)的影響及相關(guān)經(jīng)濟(jì)成本,為骶管阻滯的臨床應(yīng)用提供客觀依據(jù)。 方法采用歷史性隊(duì)列研究的方法,根據(jù)診斷標(biāo)準(zhǔn)、納入和排除標(biāo)準(zhǔn)篩選2011年6月至2013年6月在蘭州大學(xué)第一醫(yī)院小兒外科接受腹股溝斜疝高位結(jié)扎術(shù)的小兒病例。根據(jù)所使用的麻醉方式,將納入的患兒分為靜脈麻醉組(單純靜脈麻醉)和聯(lián)合麻醉組(靜脈麻醉聯(lián)合骶管阻滯),比較兩組患兒術(shù)后住院時(shí)間、術(shù)后并發(fā)癥、住院費(fèi)用、術(shù)中及術(shù)后藥物的使用情況、麻醉時(shí)間和手術(shù)時(shí)間。采用SPSS19.0軟件進(jìn)行統(tǒng)計(jì)分析。 結(jié)果共納入113例患兒,其中包括靜脈麻醉組53例,聯(lián)合麻醉組60例。兩組患兒在年齡、體重、斜疝類型方面差異無(wú)統(tǒng)計(jì)學(xué)意義,基線具有可比性。兩組在術(shù)后住院時(shí)間、術(shù)后陰囊水腫及上呼吸道感染發(fā)生率方面差異無(wú)統(tǒng)計(jì)學(xué)意義,且兩組均未出現(xiàn)切口出血、切口感染及斜疝復(fù)發(fā)。兩組在住院總費(fèi)用、床位費(fèi)及手術(shù)費(fèi)方面差異無(wú)統(tǒng)計(jì)學(xué)意義,在麻醉費(fèi)用、藥護(hù)費(fèi)用、檢查費(fèi)和治療費(fèi)方面差異有統(tǒng)計(jì)學(xué)意義。兩組在術(shù)中氯胺酮的使用率和使用量以及術(shù)后止血芳酸、抗生素、抗病毒藥物、止痛藥和止吐藥使用率方面差異無(wú)統(tǒng)計(jì)學(xué)意義,在術(shù)中芬太尼的使用率和使用量、丙泊酚的使用率以及術(shù)后止血芳酸的使用量方面差異有統(tǒng)計(jì)學(xué)意義。兩組在手術(shù)時(shí)間及麻醉時(shí)間方面差異無(wú)統(tǒng)計(jì)學(xué)意義。 結(jié)論靜脈麻醉聯(lián)合骶管阻滯可以減少小兒腹股溝斜疝高位結(jié)扎術(shù)術(shù)中麻醉藥物的使用,但對(duì)患兒術(shù)后住院時(shí)間和術(shù)后恢復(fù)無(wú)影響；在醫(yī)療費(fèi)用方面,雖然聯(lián)合骶管阻滯可以增加麻醉費(fèi)用,但可減少其他相關(guān)費(fèi)用,對(duì)住院總費(fèi)用無(wú)影響。由于歷史性隊(duì)列研究的局限性,本研究結(jié)論還需要前瞻性研究進(jìn)一步驗(yàn)證。
[Abstract]:Objective to evaluate the effect of preoperative sacral canal block on pain after high ligation of indirect inguinal hernia in children. The purpose of this study was to evaluate the effect of intravenous anesthesia combined with sacral canal block on recovery and related economic cost of high ligation of indirect inguinal hernia in children with indirect inguinal hernia by using the method of historical cohort study, and to provide an objective basis for the clinical application of sacral canal block. Methods A historical cohort study was used to select children who underwent high ligation of indirect inguinal hernia from June 2011 to June 2013 in pediatric surgery of Lanzhou University first Hospital according to diagnostic criteria. According to the anesthetic method used, the children were divided into intravenous anesthesia group (simple intravenous anesthesia) and combined anesthesia group (intravenous anesthesia combined with sacral canal block). Intraoperative and postoperative drug use, anesthetic time and operation time. SPSS 19.0 software was used for statistical analysis. Results 113 cases were included, including 53 cases in intravenous anesthesia group and 60 cases in combined anesthesia group. There was no significant difference in age, body weight and type of indirect hernia between the two groups, and the baseline was comparable. There was no significant difference in postoperative hospital stay, scrotal edema and upper respiratory tract infection between the two groups, and there was no incision bleeding, wound infection and recurrent hernia in both groups. There was no significant difference between the two groups in total hospital expenses, bed fees and operating expenses, but there were significant differences in the cost of anesthesia, drug care, examination and treatment. There was no significant difference between the two groups in the usage and usage of ketamine during operation, as well as in the use of hemostatic acid, antibiotics, antiviral drugs, painkillers and antiemetic drugs, but the usage and usage of fentanyl during the operation. There were significant differences in the usage of propofol and the use of hemostatic acid after operation. There was no significant difference in operation time and anesthesia time between the two groups. Conclusion intravenous anesthesia combined with sacral block can reduce the use of anesthetic during high ligation of indirect inguinal hernia in children, but it has no effect on hospital stay and postoperative recovery. Although combined sacral block can increase the cost of anesthesia, it can reduce other related costs and has no effect on the total cost of hospitalization. Due to the limitations of the historical cohort study, the findings of this study need to be further validated by prospective studies.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R726.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 錢麗芳;推拿配合疝帶治療小兒腹股溝疝30例[J];按摩與導(dǎo)引;2003年05期

2 廖巧玲,蔣可松;自制彈力兜帶用于小兒腹股溝疝的治療與護(hù)理[J];當(dāng)代護(hù)士(學(xué)術(shù)版);2004年09期

3 唐思;曾莊薇;;自制疝帶治療小兒腹股溝斜疝的療效觀察[J];當(dāng)代護(hù)士(�？瓢�);2011年06期

4 徐玲;自制疝帶治療小兒腹股溝斜疝[J];護(hù)士進(jìn)修雜志;1998年07期

5 姚向國(guó);賈俊香;;羅哌卡因復(fù)合利多卡因經(jīng)骶管阻滯輔助靜脈麻醉用于小兒中腹部以下手術(shù)臨床觀察[J];海峽藥學(xué);2010年06期

6 劉瑤;賈洪峰;;七氟醚與氯胺酮復(fù)和骶管阻滯在小兒疝氣手術(shù)中應(yīng)用比較[J];航空航天醫(yī)學(xué)雜志;2011年10期

7 張亞南;李新民;張賢珍;鄧永恒;方勇;;89例小兒腹股溝斜疝嵌頓時(shí)間與腸壞死關(guān)系的分析[J];臨床小兒外科雜志;2007年06期

8 高明太,趙玉元,陳健;小兒腹股溝斜疝藥物注射治療后的手術(shù)問(wèn)題探討[J];中國(guó)臨床醫(yī)學(xué);2003年03期

9 潘學(xué)文;嬰幼兒手術(shù)麻醉中急性呼吸道梗阻的分析和處理[J];浙江臨床醫(yī)學(xué);2001年04期

10 胡小華,李政;小兒腹股溝嵌頓疝手法復(fù)位臨床探討[J];小兒急救醫(yī)學(xué);2005年04期

，

本文編號(hào)：2034817