探讨腹横平面（transversus abdominis plane block, TAP）神经阻滞联合髂腹下-髂腹股沟（Ilioinguinal-iliohypogastric, IIIH）神经阻滞作为主要麻醉方法，在老年高危患者腹股沟疝修补术中应用的安全性和有效性。

选择新疆维吾尔自治区人民医院2017年4月至2018年4月收治的择期行单侧腹股沟疝修补术的68例老年高危患者。其中35例采用TAP联合IIIH神经阻滞（TAP-IIIH组），33例采用局部麻醉浸润（local anesthesia infiltration, LAI）（LAI组）。术前两组患者均给予咪哒唑仑2 mg+舒芬太尼5μg镇静。术中观察记录两组患者T1（切皮时）、T2（打开腹外斜肌腱膜时）、T3（游离疝囊时）、T4（分离腹膜前间隙置入补片时）、T5（缝合腹横筋膜时）、T6（缝合腹外斜肌筋膜）、T7（皮肤切口闭合时）时点的视觉模拟评分（visual analogue scale, VAS）；术后观察记录2、12、24 h时患者休息和运动（咳嗽）状态下的VAS；记录术中舒芬太尼追加使用量、术后患者对麻醉的满意度评分、麻醉费用、手术时间、术后恢复活动时间和住院时间。随访麻醉并发症至手术后4周。

TAP-IIIH组患者6个时点（T2～T7）的VAS均较LAI组低（t=-4.635、-7.309、-5.994、-8.888、-4.499、-8.132，均P<0.01）。术后2、12 h时，休息或活动状态下TAP组的VAS均明显低于LAI组（t=-7.295、77.283，-6.606、-3.034；P<0.05或0.01）；术后24 h时，无论休息或运动状态下，两组患者VAS的差异均无统计学意义（t=-2.293、-1.365，均P>0.05）。与LAI组患者比较，TAP-IIIH组患者舒芬太尼的追加量更少、患者满意度评分更高、手术时间更短、术后恢复活动时间更短，但麻醉费用更高，差异均有统计学意义（t=-6.433、3.639、-4.238、-2.518、21.645，P<0.05或0.01）；两组患者住院时间的差异无统计学意义（t=1.797，P>0.05），均未发生明显的麻醉相关并发症。

TAP-IIIH神经阻滞作为主要的麻醉方式在老年高危患者腹股沟疝修补术中的应用是安全有效的。

To explore the safety and efficacy of transversus abdominis plane (TAP) nerve block combined with ilioinguinal-iliohypogastric (IIIH) nerve block as the anesthesia method in the treatment of inguinal hernia in high risk elderly patients.

Sixty eight high risk elderly patients undergoing elective inguinal hernia repair from April 2017 to April 2018 in Xinjiang Uygur Autonomous Region People’s Hospital were included. Among them, 35 cases were TAP group with TAP combined with IIIH nerve block and 33 were LAI group with local anesthesia. 2mg midazolam and 5ug sufentanil were given to the two groups before the operation. The VAS scores of two groups at T1 (cutting time), T2 (opening of the external oblique aponeurosis), T3 (free sac when), T4 (separation of the separation of the preperitoneal space when the patch), T5 (suture abdominal Transverse fascia), T6 (suture abdominal oblique myofascial), T7 (skin incision closed) were observed in the operation. The VAS scores of 2h, 12h, 24h hours in rest and exertion (cough) status after the surgery were performed. The quantity of intraoperative supplemental sufentanil, the patient's satisfaction with anesthesia, anesthesia cost, operating time, postoperative recovery time, hospitalization days and anesthesia complications after 4 weeks of the operation were all recorded.

The VAS scores of 6 time points (T2-T7)in the TAP group were lower than that in LAI group (t=-4.635, -7.309, -5.994, -8.888, -4.499, -8.132; all P<0.01). The VAS scores of 2 hours and 12 hours in rest and exertion status after the operation in TAP group were significantly lower than that in LAI group (t=-7.295, 77.283, -6.606, -3.034; P<0.05 or P<0.01). There was no statistically significant difference (t=-2.293, -1.365; all P>0.05) of the VAS score assessed 24h after the operation in rest and exertion status between the two groups. Compared with patients in the LAI group, patients in the TAP-IIIH group had less sufentanil addition, higher patient satisfaction scores, shorter operative time, and shorter postoperative recovery time, but the anesthesia costs were higher. which were statistically significant (t=-6.433, 3.639, -4.238, -2.518, 21.645; P<0.05 or P<0.01). There was no statistical difference in hospital stay and postoperative anesthesia complications between the two groups (t=1.797, P>0.05).

The use of TAP combined with IIIH nerve block as the main anesthetic technique is safe and effective in inguinal hernia repair in high risk elderly patients.