超声引导下腰方肌阻滞对腹腔镜胆囊切除术患者术后胃肠功能及疼痛应激的影响  

Effect of Ultrasound-guided Quadratus Lumborum Block on Postoperative Gastrointestinal Function and Pain Stress in Patients Undergoing Laparoscopic Cholecystectomy

作　　者：邓国华[1] 顾文义[1] 王倩 陈燕 DENG Guohua;GU Wenyi;WANG Qian;CHEN Yan(Changshu Second People’s Hospital,Jiangsu Province,Changshu 215500,China;不详)

机构地区：[1]江苏省常熟市第二人民医院,江苏常熟215500

出　　处：《中国医学创新》2022年第12期1-5,共5页Medical Innovation of China

摘　　要：目的:探讨超声引导下腰方肌阻滞对腹腔镜胆囊切除术患者术后胃肠功能以及疼痛应激指标的影响。方法:选取2018年2月-2020年8月常熟市第二人民医院收治的87例胆囊切除术患者作为研究对象,采用硬币投掷法随机将其分为对照组43例和试验组44例。对照组术后采用静脉自控镇痛,试验组在此基础上联合超声引导下腰方肌阻滞镇痛。比较两组术后胃肠功能恢复情况(肠鸣音恢复时间、排气时间及排便时间);视觉模拟评分法(VAS)评价两组术后不同时间点的疼痛程度;酶联免疫吸附法测定两组术前、术后不同时间点血清疼痛介质[前列腺素E_(2)(PGE_(2))和P物质(SP)]、放射免疫法测定应激激素指标[皮质醇(Cor)和去甲肾上腺素(NE)],统计不良反应发生率。结果:试验组术后肠鸣音恢复时间、排气时间及排便时间均显著短于对照组(P<0.05)。试验组术后2、6、12、24 h的VAS评分均低于对照组(P<0.05)。两组术前PGE_(2)、SP、Cor和NE水平比较,差异均无统计学意义(P>0.05);试验组术后2、6、12、24 h的PGE_(2)、SP、Cor和NE水平均低于对照组(P<0.05)。对照组不良反应发生率为25.58%,高于试验组的9.09%(P<0.05)。结论:超声引导下腰方肌阻滞可显著改善腹腔镜胆囊切除术患者术后疼痛程度以及疼痛应激指标,促进胃肠功能尽早恢复,且不良反应少,临床上应用价值较高。Objective:To investigate the effect of ultrasound-guided quadratus lumborum block on postoperative gastrointestinal function and pain stress indexes in patients underwent laparoscopic cholecystectomy.Method:A total of 87 patients with cholecystectomy treated in Changshu Second People’s Hospital from February 2018 to August 2020 were selected as the research objects,they were randomly divided into two groups by coin throwing method,43 cases in the control group and 44 cases in the experimental group.The control group was treated with patient-controlled intravenous analgesia,and on this basis the experimental group was given combined ultrasound-guided quadratus lumborum block analgesia.Postoperative gastrointestinal function recovery(bowel sound recovery time,exhaust time and defecation time)was compared between the two groups;visual analogue scale(VAS)was used to evaluate the pain degree of the two groups at different postoperative time points;serum pain mediators[prostaglandin E_(2)(PGE_(2))and substance P(SP)]were measured by ELISA at preoperative and different time points postoperative,stress hormone markers[cortisol(Cor)and norepinephrine(NE)]were determined by radioimmunoassay,the incidence of adverse reactions was calculated.Result:The postoperative bowel sound recovery time,exhaust time and defecation time in the experimental group were significantly shorter than those in the control group(P<0.05).The VAS scores at 2,6,12 and 24 h after operation in the experimental group were lower than those in the control group(P<0.05).There were no significant differences in preoperative levels of PGE_(2),SP,Cor and NE between two groups(P>0.05);the levels of PGE_(2),SP,Cor and NE in the experimental group at 2,6,12 and 24 h after operation were lower than those in the control group(P<0.05).The incidence of adverse reactions in the control group was 25.58%,which was higher than 9.09%in the experimental group(P<0.05).Conclusion:Ultrasoundguided quadratus lumborum block can significantly improve the degree of postoperat

关 键 词：腰方肌阻滞 腹腔镜 胆囊切除术 胃肠功能 疼痛应激 

分 类 号：R657.4[医药卫生—外科学]