超声引导腰方肌后路阻滞与竖脊肌平面阻滞在剖宫产术后镇痛中的效果比较  

Effect Comparison of Ultrasound-guided Posterior Quadratus Lumborum Block and Erector Spinae Plane Block in Postoperative Analgesia after Cesarean Section

作　　者：段磊 史创国[1] 王泽鹏[1] 马欢 DUAN Lei;SHI Chuangguo;WANG Zepeng;MA Huan(Department of Anesthesiology,Xi′an Aerospace General Hospital,Xi′an 710100,China)

机构地区：[1]西安航天总医院麻醉科,西安710100

出　　处：《医学综述》2023年第4期827-832,共6页Medical Recapitulate

摘　　要：目的比较超声引导腰方肌后路阻滞(QLB2)与竖脊肌平面阻滞(ESPB)用于剖宫产术后的镇痛效果。方法选取2021年1—5月西安航天总医院腰硬联合麻醉下择期行剖宫产产妇60例,采用随机数字表法分为QLB2组和ESPB组,每组30例。术后,QLB2组于L 3横突水平行双侧QLB2,每侧注射20 ml 0.375%罗哌卡因;ESPB组于T 9横突水平行双侧ESPB,每侧注射20 ml 0.375%罗哌卡因。比较两组术后24 h纳布啡消耗量,术后2、4、8、12、24 h切口痛和宫缩痛数字疼痛评分量表(NRS),术后患者自控静脉镇痛(PCIA)及神经阻滞相关指标。结果纳布啡消耗量组间、时点间的主效应差异有统计学意义(P<0.01),组间和时点间存在交互作用(P<0.01);QLB2组术后>8~12 h和>12~24 h的纳布啡消耗量均少于ESPB组(P<0.05)。QLB2组术后24 h纳布啡消耗总量少于ESPB组[(42.3±4.7)mg比(49.3±5.1)mg](P<0.01)。QLB2组术后12 h切口痛、宫缩痛NRS评分低于ESPB组[2(1,3)分比3(2,4)分、3(0,4)分比3(3,5)分](P<0.05)。QLB2组术后首次按压PCIA泵时间晚于ESPB组(P<0.01),术后PCIA泵有效按压次数少于ESPB组(P<0.01),神经阻滞穿刺时间长于ESPB组(P<0.01),两组镇痛补救、恶心呕吐的发生率及术后镇痛满意度评分比较差异无统计学意义(P>0.05)。结论剖宫产术后实施超声引导下QLB2与ESPB均可获得较好的镇痛效果,不良反应发生率均较低。但QLB2镇痛持续时间长于EPSB、纳布啡消耗量少于ESPB,临床医师可根据患者具体情况合理选择。Objective To compare the analgesic effect of ultrasound-guided posterior quadratus lumborum block(QLB2)and erector spinae plane block(ESPB)after cesarean section.Methods Sixty women who underwent elective cesarean section under combined spinal and epidural anesthesia in Xi′an Aerospace General Hospital from Jan.2021 to May 2021 were included and divided into a QLB2 group and an ESPB group using the random number table method,with 30 cases in each group.The QLB2 group received bilateral QLB2 on L 3 transverse process level,and each side was injected with 20 ml 0.375%ropivacaine;the ESPB group received bilateral ESPB on T 9 transverse process level,and each side was injected with 20 ml 0.375%ropivacaine.The cumulative consumption of nalbuphine at 24 h postoperatively;the numerical rating scale(NRS)of incision pain and uterine contraction pain at postoperative 2,4,8,12 and 24 h,and postoperative patient-controlled intravenous analgesia(PCIA)and related indexes of nerve block of the two groups were compared.Results The main effect difference of nalbuphine consumption was statistically significant between groups and time points(P<0.01),and there was interaction between groups and time points(P<0.01).Nalbuphine consumption>8-12 h and>12-24 h after surgery in the QLB2 group were both lower than that in the ESPB group(P<0.05).Total nalbuphine consumption 24 h after operation in the QLB2 group was lower than that in the ESPB group[(42.3±4.7)mg vs(49.3±5.1)mg](P<0.01).NRS scores of incision pain and contraction pain 12 h after surgery in the QLB2 group were lower than those in the ESPB group[2(1,3)vs 3(2,4),3(0,4)vs 3(3,5)](P<0.05).The first time of PCIA in the QLB2 group was later than that in the ESPB group(P<0.01),the effective times of PCIA were less than that in the ESPB group(P<0.01),and the nerve block puncture time was longer in the QLB2 group than that in the ESPB group(P<0.01).There were no significant differences in the incidence of analgesic remedy,nausea and vomiting,and postoperative analgesic satisfactio

关 键 词：剖宫产术 腰方肌后路阻滞 竖脊肌平面阻滞 术后镇痛 

分 类 号：R614.4[医药卫生—麻醉学]