超声引导下腰方肌阻滞对腹腔镜子宫肌瘤剔除术患者镇静Ramsay评分、血清应激指标及苏醒质量的影响  

Effects of ultrasound-guided quadratus lumborum block during laparoscopic myomectomy of patients on their Ramsay sedation score, serum norepinephrine level, and recovery quality

作　　者：陈红[1] 罗爱林[1] 李世勇[1] 周志强 何满 CHEN Hong;LUO Ailin;LI Shiyong;ZHOU Zhiqiang;HE Man(Tongji Hospital,Tongji Medical College,Hua zhong University of Science and Technology,Wuhan,Hubei Province,430030)

机构地区：[1]华中科技大学同济医学院附属同济医院,武汉430030

出　　处：《中国计划生育学杂志》2022年第7期1564-1568,共5页Chinese Journal of Family Planning

基　　金：国家自然科学基金资助(81974160)。

摘　　要：目的:探讨超声引导下腰方肌阻滞(QLB)对腹腔镜子宫肌瘤剔除术(LM)患者Ramsay镇静评分、血清去甲肾上腺素(NE)水平及苏醒质量的影响.方法:选择2019年5月-2021年8月在本院行LM的患者104例,随机数字表法分为对照组(n=52)和观察组(n=52),均行全凭静脉麻醉,观察组先给予超声引导下QLB.比较两组手术前后不同时点血清应激指标皮质醇(Cor)、去甲肾上腺素(NE)水平、疼痛视觉模拟评分法(VAS)、镇静Ramsay评分、苏醒质量及不良反应发生率.结果:两组气腹后10min至术后24h血清Cor、NE水平均持续升高但观察组低于对照组(均P<0.05);两组术后6~24h静息状态下VAS评分先降低后升高,Ramsay评分逐渐升高,观察组术后6h、12h、24hVAS评分均低于对照组,Ramsay评分(2.32±0.56分、2.49±0.53分、2.64±0.46分)均高于对照组(1.57±0.42分、1.68±0.38分、1.82±0.43分)(均P<0.05);观察组呼之睁眼时间(6.69±0.83min)、拔管时间(8.17±1.14min)、苏醒时间(26.45±4.93min)均短于对照组(7.95±0.91min、9.35±1.68min、32.16±6.22min),术后不良反应发生率(5.8%)低于对照组(21.2%)(均P<0.05).结论:对LM患者实施超声引导下QLB,可明显提高镇痛镇静效果,减轻患者机体应激状况,改善术后苏醒质量且提高用药安全性.Objective: To investigate the effects of ultrasound-guided quadratus lumborum block(QLB) during laparoscopic myomectomy(LM) of patients on their Ramsay sedation score, serum norepinephrine(NE) level, and recovery quality. Methods: A total of 104 patients who wanted LM were selected and divided into two groups(52 cases in each group) according to the random number table method from May 2019 to August 2021. The patients in the control group received total intravenous anesthesia, and the patients in the study group received QLB by ultrasound guidance firstly and then received total intravenous anesthesia. The levels of serum stress indicators, such as cortisol(Cor) and norepinephrine(NE), the scores of Visual Analogue Scale(VAS) and sedative Ramsay at different time points, the recovery quality, and the incidence of adverse reactions of the patients were compared between the two groups. Results: The levels of Cor and NE of the patients in both groups from 10 min after pneumoperitoneum to 24 h after surgery had increased continuously, but which of the patients in the study group were significantly lower than those of the patients in the control group(all P<0.05). The rest VAS score of the patients in the two groups in 6-24 h after surgery had decreased firstly and then increased, while Ramsay score of the patients in the two groups in 6-24 h after surgery had increased gradually. VAS score of the patients in the study group at 6 h, 12 h, or 24 h after surgery was significantly lower than that of the patients in the control group.The Ramsay scores of the patients in the study group at 6h,12h,and 24hafter surgery(2.32±0.56points,2.49±0.53points,and 2.64±0.46points)were significantly higher than those(1.57±0.42points,1.68±0.38points,and 1.82±0.43points)of the patients in the control group(all P<0.05).The time from called to eye opening(6.69±0.83min),the extubation time(8.17±1.14min),and the wake time(26.45±4.93min)of the patients in the study group were significantly shorter than those(7.95±0.91min,9.35±1.68m

关 键 词：腹腔镜子宫肌瘤剔除术 超声引导 腰方肌阻滞 镇静 去甲肾上腺素 苏醒质量 

分 类 号：R614[医药卫生—麻醉学] R737.33[医药卫生—外科学]