超声引导下弓状韧带上腰方肌平面阻滞对老年患者结肠癌手术术中及术后镇痛效果的影响  

Effect of ultrasound-guided lumbar quadratus muscle block on the analgesic effect during and after colon cancer surgery in elderly patients

作　　者：张瑶 刘松华 王惠敏 曹理言 赵嘉慧 李洁[2] 罗婉婷 李玲[2] 李璐[2] 程智刚[3] Zhang Yao;Liu Songhua;Wang Huimin;Cao Liyan;Zhao Jiahui;Li Jie;Luo Wanting;Li Ling;Li Lu;Cheng Zhigang(Department of Anesthesiology,Hunan University of Medicine General Hospital,Huaihua 418000,China;Department of Anesthesiology,Changsha Central Hospital Afiliated to South China University,Changsha 410004,China;Department of Anesthesiology,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]湖南医药学院总医院麻醉科,怀化418000 [2]南华大学附属长沙中心医院麻醉科,长沙410004 [3]中南大学湘雅医院麻醉科,长沙410008

出　　处：《中国医师杂志》2023年第11期1624-1629,共6页Journal of Chinese Physician

基　　金：2021、2022年长沙市中心医院科研项目(YNKY202102、YNKY202232);湖南省医疗技术创新引导项目(2021SK53404)。

摘　　要：目的探讨超声引导下弓状韧带上腰方肌平面阻滞复合全身麻醉对老年患者腹腔镜下结肠癌根治术术中及术后镇痛效果的影响。方法前瞻性选取2022年5月至2023年2月在南华大学附属长沙中心医院行结肠癌根治术的老年患者61例,ASA分级Ⅱ~Ⅲ级,按照随机数字表法分为SA、GA组,SA组31例,GA组30例。SA组采用超声引导下弓状韧带上腰方肌平面阻滞复合全身麻醉,GA组采用单纯全身麻醉。记录两组患者入手术室时(T_(0))、切皮前5 min(T_(1))、切皮时(T_(2))、手术开始后30 min(T_(3))、手术结束时(T_(4))、麻醉复苏拔管时(T_(5))的MAP和HR;记录两组患者T_(5)、回到病房时(T_(6))、术后6 h(T_(7))、12 h(T_(8))、24 h(T_(9))、48 h(T_(10))的疼痛视觉模拟评分(VAS);记录术中舒芬太尼、瑞芬太尼、丙泊酚使用剂量;记录麻醉复苏时间、术后48 h内镇痛泵按压总次数、Lovett肌力评分、术后早期康复情况及术后48 h内不良反应。结果SA组在T_(1~5)时MAP和HR低于GA组(均P<0.05);SA组在T_(5~10)时疼痛VAS低于GA组(均P<0.05);SA组术中丙泊酚及瑞芬太尼、舒芬太尼用量均低于GA组(均P<0.05);SA组麻醉复苏时间、首次下床时间早于GA组(均P<0.05);术后48 h内镇痛泵按压总次数少于GA组(P<0.05);SA组术后48 h内恶心呕吐发生率低于GA组(P<0.05),两组患者术后Lovett肌力评分、住院时间和头晕发生率比较差异无统计学意义(均P>0.05)。结论超声引导下弓状韧带上腰方肌平面阻滞应用于老年患者腹腔镜结肠癌手术,能明显减少术中全麻药物和术中术后镇痛药物的使用剂量,降低患者术后疼痛评分,有效缓解患者术后疼痛,从而使得患者术后首次下床活动时间提前,术后并发症减少,促进患者快速康复。Objective To investigate the effect of ultrasound-guided lumbar quadratus muscle plane block combined with general anesthesia on the analgesic effect during and after laparoscopic colon cancer radical surgery in elderly patients.Methods A prospective study was conducted on 61 elderly patients who underwent radical colon cancer surgery at the Changsha Central Hospital Affiliated to South China University from May 2022 to February 2023,with American Society of Anesthesiologist(ASA)gradesⅡtoⅢ.They were randomly divided into SA and GA groups using a random number table method,with 31 patients in the SA group and 30 patients in the GA group.The SA group received ultrasound-guided plane block of the upper lumbar quadratus muscle in the arcuate ligament combined with general anesthesia,while the GA group received simple general anesthesia.Record the mean artery pressure(MAP)and heart rate(HR)of two groups of patients at the time of entering the operating room(T_(0)),5 minutes before skin incision(T_(1)),at skin incision(T_(2)),30 minutes after surgery(T_(3)),at surgery end(T_(4)),and during anesthesia resuscitation and extubation(T_(5));The Visual Analogue Scale(VAS)of two groups of patients at T_(5),upon returning to the ward(T_(6)),6 hours(T_(7)),12 hours(T_(8)),24 hours(T_(9)),and 48 hours(T_(10))after surgery were recorded;The dosage of sufentanil,remifentanil,and propofol used during surgery,anesthesia recovery time,total number of analgesic pump presses within 48 hours after surgery,Lovett muscle strength score,early postoperative recovery,and adverse reactions within 48 hours after surgery were also recorded.Resultsl The MAP and HR of the SA group were lower than those of the GA group at T_(1-5)(all P<0.05);The VAS score of the SA group was lower than that of the GA group at T_(5-10)(all P<0.05);The intraoperative dosage of propofol,remifentanil,and sufentanil in the SA group was lower than that in the GA group(all P<0.05);The anesthesia recovery time and first time out of bed in the SA group were earlier tha

关 键 词：结肠肿瘤 镇痛 神经传导阻滞 腰方肌 

分 类 号：R614[医药卫生—麻醉学] R735.35[医药卫生—外科学]