腰方肌阻滞联合羟考酮自控静脉镇痛用于老年患者腹腔镜结直肠癌根治术后镇痛的效果  

Analgesic effect of quadratus lumborum block combined with oxycodone controlled intravenous analgesia in elderly patients after laparoscopic radical resection of colorectal cancer

作　　者：马艳辉[1] 吴洁[1] 薛纪秀[1] 姚东旭[1] 徐娜[1] 贾宾[1] 王天龙[1] Ma Yanhui;Wu Jie;Xue Jixiu;Yao Dongxu;Xu Na;Jia Bin;Wang Tianlong(Department of Anesthesiology and Operating Theater,Xuanwu Hospital,Capital Medical University,National Clinical Research Center for Geriatric Disorders,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院麻醉手术科,国家老年疾病临床医学研究中心,北京100053

出　　处：《北京医学》2021年第12期1162-1166,共5页Beijing Medical Journal

基　　金：北京市医院管理局临床医学发展专项——“扬帆”计划(ZYLX201818)。

摘　　要：目的探讨超声引导腰方肌阻滞(quadratus lumborum block,QLB)联合羟考酮自控静脉镇痛用于老年患者腹腔镜结直肠癌根治术后镇痛的效果。方法选取2020年1月至2021年1月首都医科大学宣武医院拟行腹腔镜结直肠癌根治术的老年患者60例,采用随机数字表法分为羟考酮自控静脉镇痛组(O组)和QLB联合羟考酮自控静脉镇痛组(Q组),每组30例。Q组全身麻醉诱导前采用超声引导下双侧QLB。两组术后均行羟考酮自控静脉镇痛。记录患者术后2h(T_(1))、4 h(T_(2))、12 h(T_(3))、24 h(T_(4))、48 h(T_(5))静息时和咳嗽时的视觉模拟评分(visual analogue score,VAS)。记录术后48 h内羟考酮用量、术毕至首次按压镇痛泵时间、有效按压次数、补救镇痛患者例数和镇痛满意度评分。记录术后48 h镇痛不良反应及QLB相关并发症发生情况。结果Q组T_(1)和T_(2)时静息VAS、T_(1)~T_(4)时咳嗽VAS较O组同时点明显降低[(2.0±0.8)分比(3.6±0.7)分、(2.2±0.6)分比(3.8±0.9)分,(3.3±0.9)分比(5.0±1.0)分、(3.4±0.6)分比(4.8±1.1)分、(3.2±0.8)分比(4.5±0.9)分、(3.0±0.7)分比(4.1±0.9)分],差异均有统计学意义(P<0.05)。Q组术后48 h内羟考酮用量、有效按压次数明显少于O组[(15±6)mg比(36±8)mg、(15±6)次比(36±8)次],差异均有统计学意义(P<0.05)。Q组术毕至首次按压镇痛泵时间较O组明显延长[(11.3±2.2)h比(4.5±1.3)h],患者镇痛满意度评分明显高于O组[(92±6)分比(74±11)分],恶心呕吐发生率明显低于O组(6.7%比30.0%),差异均有统计学意义(P<0.05)。结论超声引导QLB联合羟考酮自控静脉镇痛用于老年患者腹腔镜结直肠癌根治术后镇痛安全有效,QLB可增强术后镇痛效果,减少羟考酮用量,提高患者镇痛满意度。Objectives To investigate the efficacy of ultrasound-guided quadratus lumborum block(QLB)combined with oxycodone controlled intravenous analgesia in elderly patients after laparoscopic radical resection of colorectal cancer.Methods From January 2020 to January 2021,60 elderly patients undergoing laparoscopic radical colorectal cancer surgery in Xuanwu Hospital,Capital Medical University were selected and divided into oxycodone controlled intravenous analgesia group(group O)and QLB combined with oxycodone controlled intravenous analgesia group(group Q)by random number table method,with 30 patients in each group.Before induction of general anesthesia,bilateral QLB was guided by ultrasound in group Q.Both groups received oxycodone controlled intravenous analgesia.Visual analogue score(VAS)at rest and cough were recorded at 2 h(T_(1)),4 h(T_(2)),12 h(T_(3)),24 h(T_(4))and 48 h(T_(5))after operation.The dosage of oxycodone within 48 h after operation,the time from the end of operation to the first press of the analgesic pump,the number of effective press,the number of patients with remedial analgesia and the satisfaction score of analgesia were recorded.Adverse reactions related to analgesia and QLB related complications were recorded 48 h after operation.Results The rest VAS at T_(1) and T_(2) and cough VAS at T_(1)-T_(4) in group Q were significantly lower than those in group O at the same time[(2.0±0.8)points vs.(3.6±0.7)points,(2.2±0.6)points vs.(3.8±0.9)points,(3.3±0.9)points vs.(5.0±1.0)points,(3.4±0.6)points vs.(4.8±1.1)points,(3.2±0.8)points vs.(4.5±0.9)points,(3.0±0.7)points vs.(4.1±0.9)points],the differences were statistically significant(P<0.05).The dosage of oxycodone and the number of effective press within 48 h after operation in group Q were significantly lower than those in group O[(15±6)mg vs.(36±8)mg,(15±6)times vs.(36±8)times],and the differences were statistically significant(P<0.05).The time from the end of operation to the first press of the analgesic pump in the Q group was sign

关 键 词：腰方肌阻滞 羟考酮 结直肠癌根治术 术后镇痛 老年 

分 类 号：R614[医药卫生—麻醉学]