腰方肌阻滞和腹横肌平面阻滞对开腹肝切除术患者术后镇痛效果的比较  

Comparison of Efficacy of Quadratus Lumborum Block and Transversus Abdominis Plane Block on Postoperative Analgesia in Patients with Open Hepatectomy

作　　者：张辉[1] 杨倚天 贾佳[1] 崔明珠[1] 张连仲[2] 张加强[1] 王慧慧 ZHANG Hui;YANG Yitian;JIA Jia;CUI Mingzhu;ZHANG Lianzhong;ZHANG Jiaqiang;WANG Huihui(Department of Anesthesia and Perioperative Medicine,Henan Provincial People’s Hospital,Zhengzhou 450003,China;Department of Ultrasound,Henan Provincial People’s Hospital,Zhengzhou 450003,China;Henan Academy of Medical Sciences,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院麻醉与围术期医学科,河南郑州450003 [2]河南省人民医院超声科,河南郑州450003 [3]河南省医学科学院,河南郑州450003

出　　处：《河南医学研究》2023年第12期2211-2214,共4页Henan Medical Research

摘　　要：目的比较腰方肌阻滞(QLB)和肋缘下腹横肌平面阻滞(TAP)对肝切除术患者术后镇痛效果。方法选取2021年2—9月在河南省人民医院择期行开腹肝切除术的100例患者,所有患者或家属均签署知情同意书。采用随机数字表法将患者分为QLB(Q)组(n=50)和肋缘下TAP(T)组(n=50)。分别于术前在超声引导下行外侧弓状韧带上QLB和肋缘下TAP,注入3.3 g·L^(-1)罗哌卡因30 mL。待阻滞效果确切后行常规全身麻醉和手术。记录并比较两组神经阻滞的操作时间、术后6、12、24、48 h的视觉模拟评分法(VAS)评分、术后静脉自控镇痛泵的有效按压次数。比较两组患者术中和术后不良反应(低血压、心动过缓、恶心呕吐)的发生以及术后住院天数。结果与Q组比较,T组神经阻滞的操作时间更短(P<0.05)。两组术中低血压和窦性心动过缓发生情况比较差异无统计学意义(P>0.05)。与T组比较,Q组术后6 h VAS评分更低,术后镇痛泵有效按压次数更少(P<0.05)。其他时点VAS评分以及术后恶心呕吐的发生及术后住院时间比较差异无统计学意义(P>0.05)。结论对开放性肝切除术患者,外侧弓状韧带上QLB比肋缘下TAP有更好的术后镇痛效果。Objective To observe the effects of quadrantus lumborum block(QLB)and subcostal transversal abdominis plane block(TAP)on postoperative analgesia in patients with open hepatectomy.Methods A total of 100 patients undergoing elective open hepatectomy in Henan Provincial People’s Hospital from February to September in 2021 were selected.All patients gave written informed consent for inclusion in the study.The patients were divided into QLB(Q)group(n=50)and subcostal TAP(T)group(n=50)by random number table method.QLB puncture on lateral arcuate ligament and TAP under costal margin were performed under ultrasound guidance before surgery respectively,and 3.3 g·L^(-1) ropivacaine 30 mL was injected.General anesthesia and operation were performed after the blocking effect was confirmed.The operation time of nerve block,visual analogue scale(VAS)scores at 6,12,24 and 48 hours after surgery,and the number of effective compressions of the self-controlled intravenous analgesia pump were recorded and compared between the two groups.The occurrence of intraoperative and postoperative adverse reactions(hypotension,bradycardia,nausea and vomiting)and the length of postoperative hospitalization were compared between the two groups.Results Compared with group Q,the nerve block time of group T was shorter(P<0.05).There was no statistical differences in intraoperative hypotension and sinus bradycardia between the two groups(P>0.05).Compared with group T,the VAS score of the group Q was lower at 6 hours after surgery,and the number of effective analgesic pump compressions was less(P<0.05).There were no statistical differences in VAS scores at other time points,incidence of postoperative nausea and vomiting,and postoperative hospital stay between the two groups(P>0.05).Conclusion In patients with open hepatectomy,QLB on lateral arcuate ligament is more effective in postoperative analgesia than subcostal TAP.

关 键 词：腰方肌阻滞 肋缘下腹横肌平面阻滞 开放性肝切除术 术后疼痛 

分 类 号：R614.4[医药卫生—麻醉学]