超声引导下腰方肌阻滞与腹横肌平面阻滞对腹腔镜子宫全切术后快速康复效果的影响  

Effects of ultrasound-guided psoas quadratus block and transverse abdominal plane block on rapid rehabilitation after laparoscopic hysterectomy

作　　者：杨瑜 魏星 毕生龙 YANG Yu;WEI Xing;BI Shenglong(Ganzhou Maternal and Child Health Hospital,341000 Ganzhou,China)

机构地区：[1]赣州市妇幼保健院,江西赣州341000

出　　处：《临床医药实践》2023年第9期647-650,共4页Proceeding of Clinical Medicine

基　　金：赣州市科技计划项目(项目编号:GZ2021ZSF301)。

摘　　要：目的:探究超声引导下腰方肌阻滞(QLB)与腹横肌平面阻滞(TAP)对腹腔镜子宫全切术后快速康复效果的影响。方法:选取2021年1月—2022年12月择期行腹腔镜子宫全切术的患者70例,按照随机数字表法分为QLB组和TAP组,每组35例。QLB组于超声引导下行QLB,TAP组于超声引导下行TAP。比较两组麻醉效果及术后恢复情况、血流动力学[平均动脉压(MAP)、心率(HR)]、静息疼痛视觉模拟疼痛(VAS)评分。结果:QLB组术中舒芬太尼用量、镇痛泵按压次数少于TAP组,术后首次下床活动时间、肛门排气时间短于TAP组,差异有统计学意义(P<0.05)。两组入室时(t_(1)),MAP和HR水平比较,差异无统计学意义(P>0.05);两组切皮时(t_(2))、切皮后1 min(t_(3))、气腹建立成功后1 min(t_(4))的MAP和HR水平高于t_(1),且t_(4)高于t_(2)和t_(3),t_(3)高于t_(2);QLB组t_(2),t_(3)和t_(4)的MAP和HR水平低于TAP组,差异有统计学意义(P<0.05)。两组术后2 h,4 h,8 h和12 h的静息VAS评分随着时点增加呈升高趋势,术后48 h的静息VAS评分低于术后12 h;QLB组各时点的静息VAS评分均低于TAP组,差异有统计学意义(P<0.05)。结论:与TAP相比,超声引导下QLB可减少腹腔镜子宫全切术患者的麻醉药物用量,提高镇痛效果,稳定患者的血流动力学,更利于患者术后康复。Objective:To explore the effect of ultrasound-guided quadratus lumbosae block(QLB)and transverse abdominal plane block(TAP)on rapid recovery after laparoscopic hysterectomy.Methods:A total of 70 patients undergoing elective laparoscopic hysterectomy in hospital from January 2021 to December 2022 were randomly divided into two groups,with 35 patients in each group.QLB group was performed under ultrasound guidance while TAP group was performed under ultrasound guidance.The anesthetic effect and postoperative recovery,hemodynamics mean arterial pressure(MAP),heart rate(HR),and visual analog pain(VAS)scores for resting pain were compared between the two groups.Results:In QLB group,the amount of sufentanil used during the operation,the number of times the analgesic pump was pressed,the time of first ambulation and anal exhaust in QLB group were shorter than those in TAP group(P<0.05).At the time of entry(t_(1)),there was no statistically significant difference in MAP and HR levels between the two groups(P>0.05).At the time of skin incision(t_(2)),1 minute after skin incision(t_(3)),and 1 minute after successful pneumoperitoneum establishment(t_(4)),the levels of MAP and HR in both groups were higher than those in t_(1),and at t_(4),the levels of MAP and HR were higher than those in t_(2)and t_(3),while at t_(3),the levels of MAP and HR were higher than those in t_(2).The levels of MAP and HR at t_(2),t_(3)和t_(4)in QLB group were lower than those in TAP group(P<0.05).The resting VAS scores at_(2)h,4 h,8 h,and 12 h after surgery in the two groups increased with the increase of time points.The resting VAS scores at_(4)8 h after surgery were lower than those at_(1)2 h after surgery.The resting VAS scores at each time point in the QLB group were lower than those in the TAP group(P<0.05).Conclusion:Compared with TAP,ultrasound guided QLB can reduce the amount of narcotic drugs used in patients undergoing laparoscopic hysterectomy,improve the analgesic effect,stabilize the hemodynamics of patients,and is more conducive to

关 键 词：腹腔镜子宫全切术 腰方肌阻滞 腹横肌平面阻滞 血流动力学 疼痛 

分 类 号：R713.42[医药卫生—妇产科学]