术前腰方肌阻滞与横突间阻滞对妇科腹腔镜手术患者术后疼痛和早期恢复的影响  

Effects of preoperative quadratus lumborum block and intertransverse process block on postoperative pain and early recovery in patients undergoing gynecological laparoscopic surgery

作　　者：王薇 周淑敏 黄真[2] 孙莹莹[3] WANG Wei;ZHOU Shumin;HUANG Zhen;SUN Yingying(Department of Anesthesiology,Chaoyang District Maternal and Child Health Hospital,Beijing 100012,China;Department of Obstetrics and Gynecology,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Anesthesiology,Beijing Tongren Hospital Affiliated to Capital Medical University,Beijing 100730,China)

机构地区：[1]北京市朝阳区妇幼保健院麻醉科,北京100012 [2]北京市积水潭医院妇产科,北京100035 [3]首都医科大学附属北京同仁医院麻醉科,北京100730

出　　处：《新疆医科大学学报》2024年第5期709-712,718,共5页Journal of Xinjiang Medical University

基　　金：北京市医院管理中心青年人才培养“青苗”计划项目(QML20200403)。

摘　　要：目的研究术前腰方肌阻滞与横突间阻滞对妇科腹腔镜手术患者术后疼痛和早期恢复的影响。方法以2018年12月-2022年12月北京市朝阳区妇幼保健院麻醉科收治的80例全身麻醉下行妇科腹腔镜手术患者为研究对象,随机分为腰方肌阻滞组(Q组,40例)和横突间阻滞组(T组,40例),两种阻滞均在麻醉诱导前完成。记录两组术中及术毕24、48 h内阿片类药物用量,术中心血管不良反应发生率,术后24、48 h恶心呕吐发生率,肠道排气时间以及首次下床时间。采用QoR-40量表评估术后3 d两组患者满意度。结果与Q组相比,T组术中和术后24 h舒芬太尼用量减少,术中低血压的发生率升高(10.2%vs 35%),术后3 d的QoR-15评分升高[(166.26±10.91)分vs(174.52±11.77)分],首次下床时间缩短[(18.2±4.5)h vs(16.0±4.2)h],差异均有统计学意义(P<0.05)。两组肠道排气时间和术后恶心呕吐发生率,差异无统计学意义(P>0.05)。结论在妇科腹腔镜手术中使用横突间阻滞较腰方肌阻滞可减少围术期阿片类药物用量,提高术后患者满意度。Objective To study the effects of preoperative quadratus lumborum block and transversus abdominis plane block on postoperative pain and early recovery in patients undergoing gynecological laparoscopic surgery.Methods The study included 80 patients scheduled for gynecological laparoscopic surgeries under general anesthesia at Chaoyang District Maternal and Child Health Hospital,Beijing,from December 2018 to December 2022.Participants were randomly assigned to receive either a quadratus lumborum block(Group Q,40 patients)or a transversus abdominis plane block(Group T,40 patients)prior to anesthesia induction.The research monitored opioid consumption during and up to 48 hours post-surgery,the incidence of intraoperative cardiovascular adverse events,postoperative nausea and vomiting within 48 hours,time to first flatus,and time to first ambulation.Patient satisfaction was evaluated on the third postoperative day using the QoR-40 scale.Results Compared with Q group,T group had a decrease in the amount of sufentanil used during and 24 hours after surgery,an increase in the incidence of intraoperative hypotension(10.2%vs 35%),an increase in QoR-15 score at 3 days after surgery[(166.26±10.91)vs(174.52±11.77)],and a shortened first time out of bed[(18.2±4.5)h vs(16.0±4.2)h],with statistically significant differences(P<0.05).There was no statistically significant difference(P>0.05)in the time of intestinal emptying and the incidence of postoperative nausea and vomiting between the two groups.Conclusion The use of intertransverse process block in gynecological laparoscopic surgery can reduce perioperative opioid consumption and improve early postoperative patient satisfaction compared with quadratus lumborum block.

关 键 词：腰方肌阻滞 横突间阻滞 腔镜手术 术后疼痛 

分 类 号：R459.9[医药卫生—治疗学]