不同径路腰方肌阻滞联合全麻对腹腔镜子宫切除术后疼痛和炎性因子的影响  

Effects of different lumbar quadratus block combined with general anesthesia on pain and inflammatory factors after laparoscopic hysterectomy

作　　者：王坚 宋杰 孙佳凤 姚雷 WANG Jian;SONG Jie;SUN Jia-feng(Department of Anesthesiology,the Second Affiliated Hospital of Nantong University(the First People’s Hospital of Nantong),Nantong226001,China)

机构地区：[1]南通大学第二附属医院南通市第一人民医院麻醉科,江苏南通226001

出　　处：《中国实验诊断学》2022年第10期1488-1492,共5页Chinese Journal of Laboratory Diagnosis

基　　金：江苏省医学会麻醉医学科研专项资金项目[SYH-32021-0043(2021038)]。

摘　　要：目的探讨不同径路腰方肌阻滞(QLB)联合全麻对腹腔镜子宫切除术患者术后疼痛和炎性因子的影响。方法2020年9月-2021年5月在南通大学第二附属医院拟行腹腔镜子宫切除术的70例患者纳入研究,随机分为后路腰方肌阻滞组(QLB2,Q组)和前后路联合腰方肌阻滞组(QLB2+QLB3,M组),各35例。Q组于全麻诱导后在超声引导下行双侧QLB2,M组于全麻诱导后在超声引导下行双侧QLB2+QLB3。比较两组在麻醉诱导前(T0)、手术切皮(T1)、建立人工气腹(T2)、拔出喉罩(T3)、离开麻醉恢复室(T4)时的平均动脉压(MAP)和心率(HR);比较两组患者手术过程中使用瑞芬太尼的使用剂量、同时记录有无使用麻黄碱及阿托品;比较两组术后3、6、12、24h静息和运动时的VAS评分,术后24h患者按压镇痛泵的次数,补救性镇痛人数;比较两组麻醉诱导前和术后24h的肿瘤坏死因子-α(TNF-α)和白介素-6(IL-6)水平。结果T2时,Q组MAP高于M组(P<0.05);Q组术中瑞芬太尼用量高于M组(P<0.05);Q组术后3、6、12、24h静息时和运动时VAS评分均高于M组(P均<0.05),Q组术后24h镇痛泵按压次数多于M组(P<0.05);Q组术后24小时TNF-α和IL-6均高于M组(P均<0.05)。结论QLB2+QLB3联合全麻比QLB2联合全麻,更能有效减少腹腔镜子宫切除术患者术中瑞芬太尼用量,提高术后镇痛效果,减轻炎症反应,利于患者康复。Objective To investigate the effects of different lumbar quadratus block(QLB)combined with general anesthesia on pain and inflammatory factors after laparoscopic hysterectomy.Methods 70patients undergoing laparoscopic hysterectomy in our hospital from September 2020to May 2021were randomly divided into posterior lumbar quadratus block group(QLB2,Q group)and anterior and posterior lumbar quadratus muscle block group(QLB2+QLB3,M group)with 35cases in each group.In group Q,bilateral QLB2was performed under ultrasound guidance after induction of general anesthesia,and bilateral QLB2+QLB3was performed under ultrasound guidance in M group after induction of general anesthesia.The mean arterial pressure(MAP)and heart rate(HR)before anesthesia induction(T0),skin incision(T1),artificial pneumoperitoneum(T2),laryngeal mask extraction(T3)and leaving anesthesia recovery room(T4)were compared between the two groups,and the intraoperative dosage of remifentanil,the use of ephedrine and atropine were compared between the two groups.The VAS scores at rest and exercise at 3,6,12and 24hafter operation,the times of analgesia pump pressing 24hours after operation,the number of patients with rescue analgesia,and the levels of tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)before and 24hours after anesthesia induction were compared between the two groups.Results At T2,the MAP in Q group was higher than that in M group,the intraoperative remifentanil dosage in Q group was higher than that in M group,and the VAS scores at rest and during exercise in Q group were higher than those in M group at 3,6,12and 24hafter operation.The number of analgesic pump pressing in Q group was more than that in M group 24hours after operation.TNF-αand IL-6in Q group were higher than those in M group 24hours after operation.Conclusion QLB2+QLB3combined with general anesthesia is more effective than QLB2combined with general anesthesia in reducing the dosage of remifentanil during laparoscopic hysterectomy,improving the effect of postoperative analg

关 键 词：腰方肌阻滞 超声 腹腔镜子宫切除 术后镇痛 炎性因子 

分 类 号：R614.2[医药卫生—麻醉学]