腰方肌阻滞联合静脉PCA在腹腔镜结直肠癌根治术患者围手术期镇痛的应用  

Application of quadratus lumborum block combined with perioperative intravenous PCA in patients undergoing laparoscopic radical resection of colorectal cancer

作　　者：曾磊 刘亨利 陈圆圆 ZENG Lei;LIU Hengli;CHEN Yuanyuan(Department of Anesthesiology,Second Affiliated Hospital Jiande Branch,Zhejiang University School of Medicine,Jiande 311600,CHINA)

机构地区：[1]浙江大学医学院附属第二医院建德分院麻醉科,浙江建德311600 [2]辽宁省盘锦市中心医院麻醉科

出　　处：《江苏医药》2023年第4期388-391,共4页Jiangsu Medical Journal

基　　金：杭州市医药卫生科技计划项目(B20220107)。

摘　　要：目的观察弓状韧带上腰方肌阻滞(QLB)联合静脉患者自控镇痛(PCA)在腹腔镜结直肠癌根治术围手术期的镇痛效果。方法50例全身麻醉下腹腔镜结直肠癌根治术患者随机分为A、B两组,每组25例。两组手术结束前30 min开始实施常规布托啡诺静脉PCA;A组术前加行弓状韧带上QLB,每侧注射0.375%罗哌卡因20 mL。评估两组术后6、12、24和48 h的VAS疼痛评分和Ramsay镇静评分。记录术后48 h内PCA泵按压次数和不良反应发生情况。检测术前、手术结束时、术后12和24 h的血清IL-6和IL-10水平。记录术后首次排气时间和住院时间。结果与B组比较,A组术后首次排气时间早,住院时间短,术后48 h内不良反应和PCA泵按压次数少,术后6、12、24 h的VAS疼痛评分和Ramsay镇静评分以及术后12和24 h血清IL-10水平降低,术后12和24 h血清IL-6水平升高(P<0.05)。结论弓状韧带上QLB能增强静脉PCA围手术期的镇痛效果,减少术后镇痛药用量和不良反应。Objective To observe the analgesic efficacy of quadratus lumborum block(QLB)combined with perioperative intravenous patient-controlled analgesia(PCA)in the patients undergoing laparoscopic radical resection of colorectal cancer.Methods Fifty patients undergoing laparoscopic radical resection of colorectal cancer under general anesthesia were randomized into two groups with 25cases each.Conventional intravenous PCA of butorphanol was performed in the groups of A and B,which was started on the 30minutes before the end of surgery.QLB above arcuate ligament in group A was performed with 0.375%ropivacaine 20mL each side before surgery.The VAS pain score and Ramsay score were evaluated at 6,12,24and 48hours after operation.Serum levels of IL-6and IL-10 were detected before operation,at the end of operation,and at 12and 24hours after operation.The time of the first postoperative exhaust,hospital stay,adverse responses and the number of PCA pressing within 48hours after operation were recorded.Results Compared with group B,group A had earlier the first postoperative exhaust,shorter hospital stay,less adverse responses and number of PCA pressing within 48hours after operation,lower VAS pain score and Ramsay score at 6,12and 24hours after operation,lower serum IL-10level at 12and 24hours after operation,and higher serum IL-6level at 12and 24hours after operation(P<0.05).Conclusion QLB can enhance the efficacy of intravenous PCA with reduced usage of postoperative analgesics and adverse responses.

关 键 词：腰方肌阻滞 镇痛 结直肠癌根治术 

分 类 号：R614[医药卫生—麻醉学]