超声引导下腰方肌阻滞联合丙泊酚静脉靶控输注在腹股沟斜疝手术中的应用效果  

Application effect of ultrasound-guided quadratus lumborum block combined with intravenous target-controlled infusion of Propofol during indirect inguinal hernia surgery

作　　者：谭赞全 TAN Zan-quan(Department of Anesthesiology,Shunde Hospital of Guangzhou University of Chinese Medicine,Guangdong Province,Foshan 528300,China)

机构地区：[1]广州中医药大学顺德医院麻醉科

出　　处：《中国当代医药》2019年第20期134-137,共4页China Modern Medicine

摘　　要：目的比较超声引导下腰方肌阻滞(QLB)联合丙泊酚静脉靶控输注与传统腰麻(SA)联合丙泊酚静脉靶控输注在腹股沟斜疝手术中的麻醉效果。方法选取本院2016年1月~2018年9月行单侧腹股沟斜疝行无张力修补术的95例患者,随机分为QLB组(n=48)和SA组(n=47)。QLB组采用B超引导下腰方肌阻滞麻醉+丙泊酚静脉靶控输注,SA组采用腰麻+丙泊酚静脉靶控输注。观察麻醉前及术中(麻醉后5、20、40、60min)的HR、SBP、DBP,评估患者术后第2、6、12、24、48小时的静息VAS评分,观察术后的额外镇痛干预情况、术后尿潴留情况、胃肠道不良反应情况及肠鸣音恢复情况。结果QLB组术中的心率、血压波动均少于SA组,差异有统计学意义(P<0.05),QLB组术后第6、12、24、48小时的静息VAS评分以及额外镇痛、术后尿潴留、恶心呕吐发生率均低于SA组(P<0.05),QLB组的胃肠道功能恢复时间早于SA组(P<0.05)。结论腰方肌阻滞在腹股沟斜疝手术中具有平稳、可靠的麻醉效果,术后胃肠道不良反应、尿储留发生率低,优于传统腰麻。Objective To compare the anesthetic effect of ultrasound-guided quadratus lumborum block (QLB) and traditional spinal anesthesia (SA) based on intravenous target-controlled infusion (TCI) of Propofol during indirect inguinal hernia surgery.Methods A total of 95 patients with unilateral indirect inguinal hernia undergoing tension-free hernioplasty in our hospital from January 2016 to September 2018 were selected and randomly divided into the QLB group (n=48) and the traditional spinal anesthesia (SA) group (n=47).The QLB group received QLB anesthesia guided by B-mode ultrasound -guided and intravenous TCL of Propofol,the SA group received intravenous TCI of Propofol and lumbar anesthesia.The level of HR,SBP and DBP before anesthesia and during operation (5,20,40,60 minutes after anesthesia) were observed.The resting VAS scores at 2,6,12,24,48 hours after anesthesia were evaluated.The additional analgesic intervention,urinary retention,gastrointestinal adverse reactions and recovery of bowel sounds after surgery were observed.Results The fluctuation of HR and BP during surgery in the QLB group were less marked than those in the SA group,the difference was statistically significant (P<0.05).The resting VAS score,the incidence of additional analgesia intervention,urinary retention and nausea and vomiting in the QLB group at 6,12,24 and 48 hours after operation were lower than those in the SA group (P<0.05).The recovery time of gastrointestinal function in the QLB group was earlier than that in the SA group (P<0.05).Conclusion Ultrasound-guided QLB combined with intravenous TCI of Propofol is superior to traditional spinal anesthesia due to stable vital signs during surgery,less adverse gastrointestinal reaction and urinary retention post-operation.

关 键 词：腰方肌阻滞 腰麻 腹股沟斜疝 

分 类 号：R656.2[医药卫生—外科学]