超声引导下后路腰方肌阻滞与腹横肌平面阻滞应用于小儿下腹部手术后镇痛的效果及安全性比较  

Comparison of the efficacy and safety of ultrasound-guided posterior lumbar square muscle block and transverse abdominal muscle block in the application of analgesia after lower abdominal surgery in children

作　　者：陈再治[1] 张应祥[1] 江巍[1] 苏东玲[1] 曲轶涛 熊贤俊[1] 傅志海[1] CHEN Zaizhi;ZHANG Yingxiang;JIANG Wei;SU Dongling;QU Yitao;XIONG Xianjun;FU Zhihai(Department of Anesthesiology,the Third Hospital of Xiamen City,the Third Hospital of Xiamen Affiliated to Fujian University of Traditional Chinese Medicine,Xiamen361100,China)

机构地区：[1]厦门市第三医院福建中医药大学附属厦门第三医院麻醉科,福建厦门361100

出　　处：《中国现代医生》2020年第28期129-133,共5页China Modern Doctor

摘　　要：目的探讨后路腰方肌(QL2)阻滞与腹横肌平面(TAP)阻滞在小儿下腹部腹腔镜手术后镇痛的效果及安全性。方法选择2018年6月~2019年6月本院择期全麻下腹部腹腔镜手术患儿56例,年龄1~7岁,ASAⅠ或Ⅱ级,随机分为QL2组和TAP组,每组各28例。两组神经阻滞均于全身麻醉后、手术前在超声引导下完成。术后24 h内密切随访。FLACC量表评估术后疼痛程度;记录术后24 h内予补救性镇痛患儿累积数量、平均动脉压和心率;评估并记录神经阻滞相关不良反应。结果QL2组患儿手术后1 h、2 h、4 h、6 h、12 h FLACC评分均低于TAP组(均P<0.05);QL2组手术后24 h内需要补救性镇痛患儿累积数量低于TAP组(P=0.014);QL2组患儿手术后1 h、2 h、4 h、6 h、12 h、24 h平均动脉压和心率均低于TAP组(均P<0.05)。QL2组术后有4例(14.3%)出现暂时性股四头肌无力,TAP组患儿未发现股四头肌无力;QL2组2例、TAP组1例出现单侧穿刺部位血肿。结论超声引导下QL2阻滞应用于小儿下腹部腹腔镜手术后镇痛的效果优于TAP阻滞,但存在发生暂时性股四头肌无力的风险。Objective To explore the efficacy and safety of posterior lumbar square muscle(QL2)block and transverse abdominal muscle plane(TAP)block in analgesia after laparoscopic surgery in children.Methods A total of 56 children aged 1-7 years with elective general anesthesia who underwent abdominal laparoscopic surgery,with grade ASAⅠorⅡ,were randomLy divided into QL2 group and TAP group,with 28 cases in each group.Both groups of nerve blocks were completed under general ultrasound after general anesthesia and before surgery.The patients were followed up closely within 24 hours after surgery.The FLACC scale was used to assess the degree of postoperative pain.The total number,average arterial pressure,and heart rate of children with remedial analgesia within 24 hours after the operation were recorded.The adverse reactions related to nerve block were evaluated and recorded.Results The FLACC scores of children in QL2 group were lower than those in TAP group at 1 h,2 h,4 h,6 h and 12 h after surgery(all P<0.05).The total number of children in QL2 group that required remedial analgesia within 24 hours after surgery was lower than that in TAP group(P=0.014).The average arterial pressure and heart rate of children in QL2 group at 1 h,2 h,4 h,6 h,12 h and 24 h after surgery were lower than those in TAP group(all P<0.05).Four patients(14.3%)in the QL2 group experienced temporary weakness of the quadriceps muscle.There was no weakness in the TAP group.Two patients in the QL2 group and 1 patient in the TAP group had unilateral puncture site hematoma.Conclusion Ultrasound-guided QL2 block has better postoperative analgesic effect than TAP block after lower abdominal laparoscopic surgery in children.But it has a risk of temporary quadriceps weakness.

关 键 词：超声引导 后路腰方肌阻滞 腹横肌平面阻滞 小儿 镇痛 

分 类 号：R614[医药卫生—麻醉学]