Abstract: Background　Laryngeal mask anesthesia is the main anesthesia for pediatric indirect hernia surgery.However，due to many factors such as surgical stimulation，anesthesia，inhalation anesthetics and postoperative pain，the specific cellular immune state of children can be induced.General anesthesia can not effectively inhibit the response of the body.Caudal block combined with laryngeal mask anesthesia can better maintain the immune homeostasis in children.Abdominal block（TAP）block combined with laryngeal mask anesthesia has been proved that have a good analgesic value and can significantly reduce the use of intravenous analgesics.The safety of the operation has not been proved.However，the use of the two combined anesthesia methods is rare in pediatric indirect hernia surgery.Objective　To explore the effects of sacral block or TAP block combined with laryngeal mask airway anesthesia on the stress response and immune function of children having laparoscopic indirect hernia surgery.Methods　90 cases of indirect hernia treated by laparoscopic surgery in Anhui Provincial Children's Hospital from February 2018 to February 2019 were selected and divided into group A（30 cases，only sevoflurane inhalation laryngeal mask anesthesia），group B（30 cases，sacral block combined with laryngeal mask anesthesia），and group C（30 cases，TAP block combined with laryngeal mask anesthesia）.Diastolic blood pressure（DBP），systolic blood pressure（SBP），mean arterial pressure（MAP），heart rate（HR），blood oxygen saturation（SpO2），norepinephrine（NA），cortisol（COR）and blood glucose（GLU）were recorded before the laryngeal mask placement（T0），immediately after pneumoperitoneum（T1），and 5 min（T2）after removal of the laryngeal mask airway.The levels of CD3+、CD4+、CD8+、CD4+/CD8+ were recorded before and 2 hours，12 hours and 24 hours after operation，respectively.As well as the PAED and the incidence of complications during the recovery period of pediatric anesthesia.Results　There were significant differences in DBP，SBP，MAP，HR，SpO2 at T1 and T2 among the three groups（P<0.05）.SBP，DBP，MAP，HR in group B and group C were lower than those in group A，while SpO2 was higher than that in group A（P<0.05）.DBP、SBP，MAP，HR in group A at T1 and T2 were higher than those at T0，while SpO2 was lower at T0（P<0.05）；in group B，SBP at T1 and T2 was lower than that at T0，MAP at T0 was higher than that at T1 and lower than T2，and MAP at T1 was lower than that at T2（P<0.05）；in group C，SBP at T1 and T2 was lower than T0，MAP at T0 was higher than that at T1 and lower than T2，MAP at T1 was lower than T2，HR at T0 was higher than that at T1 and lower than T2，HR at T1 was lower than T2，SpO2 at T1 was lower than T0 and T2（P<0.05）.There were significant differences in NA，COR and GLU at T1 and T2 among the three groups（P<0.05）；the levels of NA，COR and GLU in group A were higher than those in group B and group C at T1 and T2，while those in group B were lower than those in group C at T1 and T2（P<0.05）.In group A，NA，COR and GLU at T1 and T2 were higher than those at T0（P<0.05）；the NA of group B at T1 and T2 was lower than that at T0，and GLU was higher than that at T0（P<0.05）；the COR and GLU of group C at T1 and T2 were higher than those at T0（P<0.05）.There were statistically significant differences in CD3+，CD4+，CD4+/CD8+ at 12 h after operation among the three groups（P<0.05）；the levels of CD3+、CD4+、CD4+/CD8+ in group A were lower than those in group B，and CD3+、CD4+ were lower than those in group C at 12 h after operation（P<0.05）.The levels of CD3+、CD4+、CD4+/CD8+ at 12 h and 24 h after operation were lower than those before operation，and CD3+ at 2 h after operation were lower than those before operation（P<0.05）；the levels of CD4+、CD4+/CD8+ in group A at 2 h after operation were lower than those before operation（P<0.05）.The PAED scores in group A were higher than those in group B，and the incidence of complications was higher than that in groups B and C（P<0.05）.Conclusion　The sacral block combined with laryngeal mask anesthesia can effectively relieve the stress response in children with indirect inguinal hernia.It will be a better anesthetic method for children undergoing laparoscopic surgery.

Key words: Anesthesia, General anesthesia of laryngeal mask, Laparoscopy, Indirect hernia, Immune function, Stress response, Sacral block, Transabdominal muscle block

摘要： 背景　目前喉罩全麻是小儿斜疝手术最主要的麻醉方式，但由于手术刺激、麻醉操作及吸入性麻醉药物、术后疼痛等诸多原因会造成患儿特异性细胞免疫状态，全麻无法有效地抑制机体应激反应。骶管阻滞能够阻断手术部位传入神经冲动，骶管阻滞复合喉罩全麻可更好地维护小儿免疫功能稳态；腹横肌（TAP）阻滞复合喉罩全麻也被证实具有较好的镇痛作用，并且可以显著降低静脉镇痛药物的使用量，提升手术的安全性。但目前两种复合麻醉手段在小儿斜疝手术治疗中的应用较少。目的　探讨骶管阻滞或TAP阻滞复合喉罩全麻对腹腔镜下斜疝手术患儿应激反应及免疫功能的影响。方法　选取2018年2月—2019年2月安徽省儿童医院收治的行腹腔镜下手术治疗的斜疝患儿90例为研究对象，依据麻醉方式的不同分为A组（30例，仅行七氟醚吸入喉罩全麻）、B组（30例，行骶管阻滞复合喉罩全麻）、C组（30例，行TAP阻滞复合喉罩全麻），记录3组患儿喉罩放置前（T0）、建立气腹后即刻（T1）、拔除喉罩后5 min（T2）时舒张压（DBP）、收缩压（SBP）、平均动脉压（MAP）、心率（HR）、血氧饱和度（SpO2）、去甲肾上腺素（NA）、皮质醇（COR）及血糖（GLU），记录术前，术后2、12、24 h时CD3+、CD4+、CD8+、CD4+/CD8+，以及小儿麻醉苏醒期躁动量化评分（PAED）和并发症发生情况。结果　3组患儿T1、T2时DBP、SBP、MAP、HR、SpO2比较，差异均有统计学意义（P<0.05）；其中B、C组患儿T1、T2时DBP、SBP、MAP、HR低于A组，SpO2高于A组（P<0.05）。A组患儿T1、T2时DBP、SBP、MAP、HR高于T0时，SpO2低于T0时（P<0.05）；B组患儿T1、T2时SBP低于T0时，T0时MAP高于T1时、低于T2时，T1时MAP低于T2时（P<0.05）；C组患儿T1、T2时SBP低于T0时，T0时MAP高于T1时、低于T2时，T1时MAP低于T2时，T0时HR高于T1时、低于T2时，T1时HR低于T2时，T1时SpO2低于T0、T2时（P<0.05）。3组患儿T1、T2时NA、COR、GLU比较，差异均有统计学意义（P<0.05）；其中A组患儿T1、T2时NA、COR、GLU高于B、C组，B组患儿T1、T2时NA、COR、GLU低于C组（P<0.05）。A组患儿T1、T2时NA、COR、GLU高于T0时（P<0.05）；B组患儿T1、T2时NA低于T0时、GLU高于T0时（P<0.05）；C组患儿T1、T2时COR、GLU高于T0时（P<0.05）。3组患儿术后12 h CD3+、CD4+、CD4+/CD8+比较，差异均有统计学意义（P<0.05）；其中A组患儿术后12 h CD3+、CD4+、CD4+/CD8+低于B组，CD3+、CD4+低于C组（P<0.05）。各组患儿术后12 h、术后24 h CD3+、CD4+、CD4+/CD8+低于术前，术后2 h CD3+低于术前（P<0.05）；A组患儿术后2 h CD4+、CD4+/CD8+低于术前（P<0.05）。A组患儿PAED高于B组，并发症发生率高于B、C组（P<0.05）。结论　斜疝患儿行腹腔镜下手术治疗时采用骶管阻滞复合喉罩全麻可有效减轻机体应激反应，对患儿免疫功能影响较低，是腹腔镜下手术治疗患儿较好的麻醉手段。

关键词: 麻醉, 喉罩全麻, 腹腔镜, 斜疝, 免疫功能, 应激反应, 骶管阻滞, 腹横肌阻滞