腰方肌阻滞与腹横肌平面阻滞用于老年患者腹部手术后镇痛效果的比较  

Comparison of quadratus lumborum block and transversus abdominis plane block for postoperativeanalgesia in elderly patients undergoing abdominal surgery

作　　者：贺文泉 李勇帅[1] 张序昊[1] 易斌[1] 鲁开智[1] He Wenquan, Li Yongshuai, Zhang Xu- hao, Yi Bin, Lu Kaizhi(Department of Anesthesiology, First Hospital, Third Military Medical University, Chongqing 400038, Chin)

机构地区：[1]第三军医大学第一附属医院麻醉科,重庆市400038

出　　处：《中华麻醉学杂志》2018年第1期40-43,共4页Chinese Journal of Anesthesiology

基　　金：第三军医大学第一附属医院智慧医疗项目（swh2016zdcx4310）

摘　　要：目的比较腰方肌阻滞与腹横肌平面阻滞用于老年患者腹部手术后镇痛的效果。 方法择期行腹腔镜胆囊切除术的老年患者72例，性别不限，年龄65～72岁，体重指数18～25 kg/m2，ASA分级Ⅱ或Ⅲ级，采用抛硬币法，将患者随机分为2组（n＝36）：腹横肌平面阻滞组（T组）和腰方肌阻滞组（Q组）。常规麻醉诱导和麻醉维持。T组行超声引导下双侧肋缘下腹横肌平面阻滞；Q组行超声引导下双侧脊柱旁入路横穿腰方肌阻滞。阻滞完成后30 min时记录感觉阻滞范围。阻滞完成后30 min、术后1、6、12、24和48 h时记录Ramsay镇静评分和舒适度（BCS）评分。记录术后48 h内补救镇痛药帕瑞昔布钠和芬太尼使用情况、恶心、呕吐、下肢阻滞和局麻药中毒等并发症的发生情况。 结果T组阻滞范围为T4-L1，主要集中的阻滞区域为T6-11；Q组的阻滞范围为T4-L4，主要集中的阻滞区域为T6-L1。与T组比较，Q组帕瑞昔布钠和芬太尼使用率、恶心呕吐发生率降低（P〈0.05），Ramsay评分和BCS评分差异无统计学意义（P〉0.05）。 结论腰方肌阻滞用于老年患者腹部手术后镇痛的效果优于腹横肌平面阻滞。Objective To compare the quadratus lumborum block and trausversus abdominis plane block for postoperative analgesia in elderly patients undergoing abdominal surgery. Methods Seventy-two elderly patients of both sexes, aged 65-72 yr, with body mass index of 18-25 kg/m2, of American Society of Anesthesiologists physical status 11 or m, scheduled for elective laparoscopic cholecystectomy, were di- vided into 2 groups （n= 36 each） by coin toss： transversus abdominis plane block group （group T） and quadratus lumborum block group （group Q）. Anesthesia was induced and maintained routinely. Bilateral gubcostal transversus abdominis plane block was performed under ultrasound guidance in group T. Bilateral paravertebral approach to quadratus lumborum block was performed under ultrasound guidance in group Q. The height of sensory block was assessed at 30 rain after block. Ramsay sedation scores and Bruggrmann comfort scale scores were recorded at 30 rain after block and l, 6, 12, 24 and 48 h after operation. The requirement for parecoxib and fentanyl as rescue analgesics and complications such as nausea, vomiting, block of lower extremities and local anesthetic intoxication were recorded within 48 h after operation. Re- sults The height of sensory block was kept at T4-L1 , and the main blocking area was T6.11 in group T. The height of sensory block was kept at T4-L4, and the main blocking area was T6-L1 in group Q. Compared with group T, the blocking area was enlarged, the requirement for parecoxib and fentanyl and incidence of nausea and vomiting were significantly decreased （P〈0. 05） , and no significant change was found in Ram-say sedation scores or Bruggrmann comfort scale scores in group Q （P〉 0. 05）. Conclusion Quadratus lumborum block provides better efficacy for postoperative analgesia than transversus abdominis plane block in elderly patients undergoing abdominal surgery.

关 键 词：神经传导阻滞 腰肌 腹肌 老年人 镇痛 

分 类 号：R614[医药卫生—麻醉学]