开腹子宫切除术中QLB-LSAL与双侧TAPB阻滞麻醉镇痛效果比较  

Comparison of the analgesic effect of ultrasound guided anterior quadratus lumborum block at the lateral supra arcuate lig-ament and bilateral transverse abdominis plane block for anesthesia during the total abdominal hysterectomy

作　　者：聂亮[1] 胡芸 伍伦权 张雪峰 NIE Liang;HU Yun;Wu Lunquan;ZHANG Xuefeng(Fushun County People's Hospital,Zigong,Sichuan Province,643200)

机构地区：[1]四川省富顺县人民医院,643200

出　　处：《中国计划生育学杂志》2024年第2期317-321,共5页Chinese Journal of Family Planning

摘　　要：目的:分析超声引导下外侧弓状韧带上腰方肌前路阻滞(QLB-LSAL)与双侧腹横肌平面阻滞(TAPB)在开腹子宫切除术(TAH)中的麻醉效果。方法:选取2022年1月-2023年1月本院择期行TAH患者95例,根据入院顺序按单双号分为48例QLB-LSAL组(超声引导下行双侧QLB-LSAL)和47例TAPB组(超声引导下行双侧TAPB),比较两组入室(T0)、切皮时(T1)、手术结束时(T2)、拔管时(T3)及离开麻醉恢复室时(T4)的心率(HR)及平均动脉压(MAP),比较术后48h舒芬太尼消耗量、补救镇痛例数及术后48h内镇痛泵按压次数,比较术后4h、8h、12h、24h静息及咳嗽时视觉疼痛模拟评分(VAS),统计两组术后不良反应和神经阻滞并发症发生情况。结果:两组MAP及HR均呈先上升后降低趋势,且QLB-LSAL组在T1和T2时低于TAPB组(P<0.05);QLB-LSAL组术后48h舒芬太尼消耗量(69.45±4.20μg)、补救镇痛(6.3%)及术后48h内镇痛泵按压(10.5±2.3次)均低于TAPB组(73.15±4.35μg、21.3%、12.2±4.4次)(均P<0.05);两组术后静息及咳嗽时VAS评分均呈降低趋势(P<0.05),两组术后4h、8h评分无差异(P>0.05),术后12h、24h静息及咳嗽时评分QLB-LSAL组低于TAPB组(均P<0.05);两组不良反应(6.3%、4.3%)无差异(P>0.05),两组均无神经阻滞情况发生。结论:相比于双侧TAPB阻滞,超声引导下QLB-LSAL阻滞在TAH中镇痛效果更佳,能有效降低镇痛药物使用剂量,减轻受术患者的疼痛应激反应。Objective:To analyze the analgesic effect of ultrasoundguided anterior quadratus lumborum block at the lat-eral supra-arcuate ligament(QLB-LSAL)and bilateral transverse abdominis plane block(TAPB)for anesthesia during total abdominal hysterectomy(TAH)of patients.Methods:95 patients who underwent selective TAH were selected in this study from January 2022 to January 2023.According to the single-double number of the admission sequence,these patients were divided into 48 cases with QLB-LSAL for anesthesia in group A(single number of the admission se-quence)and 47 cases with TAPB for anesthesia in group B(double number of the admission sequence).The heart rate(HR)and the mean arterial pressure(MAP)values of the patients at the time of entry(T0),at the skin incision(T1),at the end of surgery(T3)and at the time of leaving the anesthesia recovery room(T4),the consumption of sufentanil at 48 h after surgery,the number of patients with remedial analgesia,the number frequency of analgesic pump compression within 48h after surgery,and the scores of pain evaluated by visual analogue scale(VAS)at rest and at cough situations of the patientsat4 h,8 h,12 h and 24 h after surgery were compared between the two groups.The rates of postoperative adverse reactions and complications related with nerve block of the patients in the two groups were analyzed statistically.Results:The values of MAP and HR of the patients in the two groups had increased firstly and then decreased significantly,and which of the patients in group A at T1 and T2 were significantly lower than those of the patients in group B(P<0.05).The consumption of sufentanil(69.45±4.20μg)at postoperative 48h,the rate of remedial analgesia(6.3%)and the number of analgesic pump pressing(10.5±2.3 times)of the patients in group A were significantly lower than those(73.15±4.35μg,21.3%and 12.2±4.4 times)of the patients in group B(all P<0.05).The postoperative VAS scores of the patients in both groups at rest and at cough showed a decreasing trend(P<0.05),but which of the p

关 键 词：开腹子宫切除术 腰方肌前路阻滞 腹横肌平面阻滞 镇痛效果 

分 类 号：R614[医药卫生—麻醉学]