腰方肌前路阻滞联合全麻对腹腔镜直肠癌根治术患者术后镇痛的效果研究  

Postoperative analgesic efficacy of anterior quadratus lumborum block combined with general anesthesia in patients undergoing laparoscopic radical resection of rectal cancer

作　　者：张宇峰[1] 周维纲[1] ZHANG Yu-feng;ZHOU Wei-gang(Department of Anesthesiology,Hanzhong Central Hospital,Hanzhong 723000,China)

机构地区：[1]陕西省汉中市中心医院麻醉科,汉中723000

出　　处：《中国肿瘤临床与康复》2020年第9期1101-1104,共4页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的探讨腰方肌前路阻滞联合全麻对腹腔镜直肠癌根治术患者术后镇痛的效果。方法选取2017年12月至2019年12月间陕西省汉中市中心医院收治的60例直肠癌患者为研究对象。根据麻醉方法不同进行分组,其中,采用静吸复合全身麻醉的30例患者纳入对照组,采用腰方肌前路阻滞联合全麻的30例患者纳入观察组。比较两组患者的围术期相关指标、术后恢复情况、病人自控镇痛(PCA)按压次数、术后谵妄及不良反应发生情况。结果两组患者的手术时间、术中出血量和舒芬太尼用量比较,差异无统计学意义(P>0.05),观察组患者的瑞芬太尼用量显著少于对照组患者,差异有统计学意义(P<0.05)。观察组患者苏醒时间、肛门首次排气时间、首次下床时间和住院时间均短于对照组患者,差异均有统计学意义(均P<0.05)。观察组术后0~6h、6~12h和12~24h的PCA按压次数均少于对照组,差异均有统计学意义(均P<0.05)。两组患者皮肤瘙痒和胸闷的发生率比较,差异无统计学意义(P>0.05),观察组患者术后谵妄和恶性呕吐的发生率均低于对照组患者,差异均有统计学意义(均P<0.05)。结论腰方肌前路阻滞联合全麻可显著减少腹腔镜直肠癌根治术患者瑞芬太尼用量,较少PCA按压次数,缓解术后疼痛,降低术后谵妄和恶性呕吐的发生率,利于患者术后恢复。Objective To investigate the postoperative analgesic efficacy of anterior quadratus lumborum block combined with general anesthesia in patients undergoing laparoscopic radical resection of rectal cancer.Methods A total of 60 patients with rectal cancer admitted to Hanzhong Central Hospital from December 2017 to December 2019 were selected as the study subjects.They were divided into an observation group and a control group based on the analgesic approach.Thirty patients receiving anterior quadratus lumborum block combined with general anesthesia were included in the observation group and 30 patients receiving intravenous-inhalation combined anesthesia were included in the control group.The perioperative indicators,postoperative recovery,demand dose of patient controlled analgesia(PCA),postoperative delirium and adverse reactions were compared between the two groups.Results There were no statistically significant differences in the operation time,intraoperative blood loss and sufentanil dosage between the two groups(P>0.05).The remifentanil dosage was significantly less in the observation group than that in the control group(P<0.05).The awakening time,time to anal exhaust,time to out-of-bed activity and length of hospital stay was significantly shorter in the observation group than in the control group(all P<0.05).The demand dose of PCA was significantly lower in the observation group than in the control group at 0~6 h,6~12 h and 12~24 h(all P<0.05).There was no statistically significant difference in the incidence of skin itching and chest tightness between the two groups(P>0.05).The incidence of postoperative delirium and nausea and vomiting was significantly lower in the observation group than in the control group(all P<0.05).Conclusion Anterior quadratus lumborum block combined with general anesthesia can significantly reduce the dosage of remifentanil,reduce the demand dose of PCA,relieve postoperative pain,reduce the incidence of postoperative delirium and nausea and vomiting,and facilitate postoperative rec

关 键 词：腰方肌前路阻滞 全麻 腹腔镜直肠癌根治术 镇痛 效果 

分 类 号：R735.3[医药卫生—肿瘤]