腰方肌阻滞联合全身麻醉用于经皮肾镜取石术患者的改良效果  

Modifying efficacy of quadratus lumborum block combined with general anesthesia in patients undergoing percutaneous nephrolithotomy

作　　者：余亮[1] 沈敏强[2] 高斌[1] 张国强[1] 张郑铎 Yu Liang;Shen Minqiang;Gao Bin;Zhang Guoqiang;Zhang Zhengduo(Department of Anesthesiology, Huzhou Central Hospital, Huzhou 313000,China;Department of Urology, Huzhou Central Hospital, Huzhou 313000,China)

机构地区：[1]湖州市中心医院麻醉科,313000 [2]湖州市中心医院泌尿外科,313000

出　　处：《中华麻醉学杂志》2019年第4期455-458,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价腰方肌阻滞联合全身麻醉用于经皮肾镜取石术患者的改良效果。方法择期全麻下行经皮肾镜取石术患者60例,年龄33~64岁,BMI 18~27 kg/m^2,性别不限,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为2组(n=30):全身麻醉组(GA组)和腰方肌阻滞联合全身麻醉组(QLB+GA组)。QLB+GA组于麻醉诱导前在超声引导下行术侧腰方肌前路阻滞,注入0.375%罗哌卡因20 ml。静脉注射咪达唑仑、异丙酚、舒芬太尼和顺式阿曲库铵行麻醉诱导;静脉输注异丙酚、瑞芬太尼和顺式阿曲库铵行麻醉维持。术毕行PCIA,配方:舒芬太尼2 μg/kg用生理盐水稀释至100 ml,背景输注速率2 ml/h,PCA剂量2 ml,锁定时间15 min,维持疼痛数字评分≤3分;当疼痛数字评分≥4分时静脉注射氟比诺芬酯50 mg行镇痛补救。记录术中丙泊酚和瑞芬太尼用量、PACU内不良反应(恶心呕吐、躁动、呼吸抑制和嗜睡)的发生情况、术后48 h内PCIA舒芬太尼用量、PCA有效按压次数、镇痛补救情况、肠道恢复排气时间和术后住院时间。结果与GA组比较,QLB+GA组术中异丙酚和瑞芬太尼用量减少,术后48 h内镇痛补救率、PCIA舒芬太尼用量和PCA有效按压次数降低,PACU内躁动、呼吸抑制和嗜睡发生率降低,肠道恢复排气时间和术后住院时间缩短(P<0.05)。结论相对于单纯全身麻醉而言,腰方肌阻滞联合全身麻醉用于经皮肾镜取石术患者,有助于实现低阿片类药物麻醉模式,更有利于抑制术后痛敏反应和促进术后恢复。Objective To evaluate the modifying efficacy of quadratus lumborum block (QLB) combined with general anesthesia in the patients undergoing percutaneous nephrolithotomy (PCNL). Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 33-64 yr, with body mass index of 18-27 kg/m2, scheduled for elective PCNL with general anesthesia, were divided into general anesthesia group (group GA) and QLB combined with general anesthesia group (group QLB+ GA), with 30 patients in each group.In group QLB+ GA, the anterior approach to QLB was performed with 0.357% ropivacaine 20 ml on the side of operation under the ultrasound guidance before induction of anesthesia.Anesthesia was induced with IV midazolam, propofol, sufentanil and cisatracurium.Anesthesia was maintained by intravenously infusing propofol, remifentanil and cisatracurium.Patient-controlled intravenous analgesia (PCIA) was performed at the end of operation.PCIA solution contained sufentanil 2 μg/kg in 100 ml of normal saline.The PCA pump was set up with a 2 ml bolus dose, a 15-min lockout interval, and background infusion at a rate of 2 ml/h.Numeric rating scale score was maintained ≤ 3 after operation.When numeric rating scale score ≥4, flurbiprofen axetil 50 mg was intravenously injected as rescue analgesic.The intraoperative consumption of propofol and remifentanil, occurrence of adverse reactions (nausea and vomiting, agitation, respiratory depression, somnolence) in postanesthesia care unit, consumption of sufentanil for PCIA within 48 h after operation, the number of successfully delivered doses, requirement for rescue analgesics, recovery time of intestinal exhaust gas, and length of postoperative hospital stay were recorded. Results Compared with group GA, the intraoperative consumption of propofol and remifentanil was significantly reduced, the rate of rescue analgesia, consumption of sufentanil for PCIA within 48 h after operation and the number of successfully delivered doses were decreased, the incidence of agi

关 键 词：神经传导阻滞 腰肌 麻醉 全身 

分 类 号：R614[医药卫生—麻醉学]