超声引导下腰方肌阻滞用于全子宫切除术后镇痛的效果研究  

Ultrasound-guided quadratus lumborum block for analgesia after total hysterectomy

作　　者：王健[1] 叶西就[2] WANG Jian;YE Xijiu(The First Affiliated Hospital of Hainan Medical College,Haihou,Hainan 570102;Sun Yat.sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510289,China)

机构地区：[1]海南医学院第一附属医院麻醉科,海南海口570102 [2]中山大学孙逸仙纪念医院麻醉科,广州510289

出　　处：《岭南现代临床外科》2018年第2期183-187,共5页Lingnan Modern Clinics in Surgery

摘　　要：目的观察超声引导下腰方肌阻滞用于全子宫切除术后镇痛的效果及不良反应。方法择期全身麻醉下进行的经腹全子宫切除术40例,年龄40~55岁,ASA分级Ⅰ~Ⅱ级,分为两组,每组20例,观察组为罗哌卡因组;对照组为0.9%氯化钠溶液组。手术后于超声引导下行双侧腰方肌阻滞。术后患者均携带经静脉自控止痛泵(PCIA)。比较两组于术后2 h、12 h、24 h、48 h静止和运动时的视觉模拟疼痛评分(VAS),记录两组术后镇痛泵按压次数、病房止痛药物使用次数及剂量、患者下床活动时间、术后首次排气时间以及不良反应。结果与对照组相比:观察组在术后2 h、12 h、24 h的静态VAS评分低于对照组(P<0.05),观察组在术后2 h、12 h、24 h、48 h的动态VAS评分低于对照组(P<0.05),观察组在术后2 h、12 h、24 h镇痛泵的按压次数、镇痛泵用量低于对照组(P<0.05),观察组在术后2 h、12 h、24 h的病房加用止痛药的次数和剂量较对照组少(P<0.05),两组在下床活动时间、术后首次排气时间及疲乏、皮肤瘙痒、恶心呕吐等不良反应方面无明显差异,不具有统计学意义(P>0.05)。结论超声引导下腰方肌阻滞用于全子宫切除术术后镇痛,缓解术后疼痛效果良好,且无明显不良反应。Objective To observe the effect and adverse reaction of the quadratus lumborum block after total hysterectomy.Methods A randomized,double-blind,controlled trial was performed.Forty patients who were age 43 to 55 years old and A SA classⅠ~Ⅱwas randomly divided into two groups and received bilateral ultrasound-guided quadratus lumborum block with either 0.4 mL/kg(2.5 mg/mL)ropivacaine or saline after total hysterectomy.A ll the patients received a postoperative analgesic regimen of sufentanil,dezocine administered by a patient-controlled pump.Then we recorded the visual analogue scores(V A S)of 2,12,24,48 hours after operation,the times pressing the analgesic pump button,the times and the dosage of oxycodone used in ward,the time getting out of bed,the first time of exhaust after operation and the side effects.Results The observation group has a lower visual analogue scores for resting at 2,12,24 hours after operation,a lower moving V A S at 2,12,24,48 hours after operation,the less times of pressing the analgesic pump button,the less times and the dosage of oxycodone used in ward.There were no more significant difference found in two groups.Conclusion Ultrasound-guided quadratus lumborum block can reduce postoperative pain for patients after total hysterectomy.

关 键 词：腰方肌阻滞 超声引导 术后镇痛 

分 类 号：R614.2[医药卫生—麻醉学]