外侧弓状韧带上腰方肌阻滞在腹腔镜肾囊肿去顶减压术患者术后镇痛效果的评价  

Evaluation of analgesic effect of anterior quadratus lumborum block at the lateral supra-arcuate ligament after laparoscopic renal cyst decompression

作　　者：高震南 贾梦醒 丁文平 李响 余莲雅 李育美 GAO Zhennan;JIA Mengxing;DING Wenping;LI Xiang;YU Lianya;LI Yumei(The Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,Jiangsu,China)

机构地区：[1]徐州医科大学附属医院,江苏徐州221000

出　　处：《西部医学》2024年第4期518-523,共6页Medical Journal of West China

基　　金：徐州市卫生健康委员会科技项目(XWKYHT20220088)。

摘　　要：目的探讨超声引导下前路和外侧弓状韧带上腰方肌阻滞在腹腔镜肾囊肿去顶减压术患者术后的镇痛效果。方法选取2022年7月—12月在徐州医科大学附属医院行择期腹腔镜肾囊肿去顶减压术患者99例为观察对象,随机分为单纯全身麻醉组(G组)、全麻联合前路腰方肌阻滞组(Q组)、全麻联合外侧弓状韧带上腰方肌阻滞组(QA组),每组33例。神经阻滞均于麻醉诱导前实施。记录患者术后24 h舒芬太尼用量、镇痛泵首次按压时间、术中瑞芬太尼用量,拔管后各时间点安静和咳嗽时的视觉模拟评分(VAS),术后24 h内补救镇痛例数,术后24 h恢复质量恢复评分(QoR-40),下肢肌力,术后恶心呕吐及感染、血肿、皮下气肿、肩痛等并发症的发生率。结果Q组和QA组患者术后24 h舒芬太尼用量低于G组,QA组低于Q组(P<0.05);Q组和QA组患者镇痛泵首次按压时间晚于G组,QA组晚于Q组(P<0.05);Q组与QA组患者术后24 h VAS评分均低于G组,T7~T9时间点QA组患者安静时VAS评分低于Q组(P<0.05),T8~T9时间点QA组患者咳嗽时VAS评分低于Q组(P<0.05);Q组和QA组患者术中瑞芬太尼用量低于G组,Q组和QA组之间比较差异无统计学意义(P>0.05);Q组和QA组患者术后24 h QoR-40评分高于G组,Q组和QA组之间比较差异无统计学意义(P>0.05);Q组和QA组患者术后24 h内补救镇痛例数低于G组,Q组和QA之间比较差异无统计学意义(P>0.05);3组患者均未出现下肢肌力减退,术后恶心呕吐及术后感染、血肿、皮下气肿、肩痛等并发症的发生率比较差异无统计学意义(P>0.05)。结论对于腹腔镜肾囊肿去顶减压术患者,外侧弓状韧带上腰方肌阻滞术后镇痛效果较前路腰方肌阻滞更理想,可以明显减少术后阿片类药物的用量,延长镇痛时间。Objective To investigate the analgesic effect of ultrasound guided anterior and quadratus lumborum block at the lateral supra-arcuate ligament after laparoscopic renal cyst decompression.Methods 99 patients with renal cyst undergoing selective laparoscopic decompression were selected and randomly divided into general anesthesia group(G group),general anesthesia with anterior quadratus lumborum block group(Q group)and general anesthesia with anterior quadratus lumborum block at the lateral supra-arcuate ligament group(QA group).Nerve block was performed before anesthesia induction.The recorded indexes include dosage of sufentanil 24h after operation,first press time of analgesia pump,intraoperative remifentanil dosage,VAS scores with quiet and cough at each time point after extubation,cases of rescue analgesia within 24 hours after operation,recovery quality scores 24h after operation,lower limb muscle strength,incidence of postoperative nausea and vomiting,infection,hematoma,subcutaneous emphysema and shoulder pain.Results The dosages of sufentanil 24h after operation in group Q and QA were lower than that in group G,group QA was lower than group Q(P<0.05).The first press time of analgesia pump in group Q and QA were later than that in group G,group QA was later than group Q(P<0.05).The VAS scores of patients in group Q and QA were lower than those in group G,the VAS scores in group QA was lower than that in group Q with quiet at T7~T9 time points(P<0.05),the VAS scores in group QA was lower than that in group Q with cough at T8~T9 time points(P<0.05).There was no significant difference in the incidence of postoperative nausea and vomiting,infection,hematoma,subcutaneous emphysema and shoulder pain in the three groups(P>0.05).Conclusion For patients undergoing laparoscopic renal cyst decompression,the analgesic effect of anterior quadratus lumborum block at the lateral supra-arcuate ligament is better than that of anterior quadratus lumborum block,which can significantly reduce the dosage of opioids and prolong t

关 键 词：肾囊肿去顶减压术 外侧弓状韧带上腰方肌阻滞 术后镇痛 腹腔镜 

分 类 号：R614.4[医药卫生—麻醉学]