超声引导下弓状韧带上腰方肌阻滞用于腹腔镜消化道肿瘤手术的有效性及安全性  

Efficacy and safety of ultrasound-guided of lumbar square muscle block on the arcuate ligament in laparoscopic surgery for gastrointestinal tumors

作　　者：崔晓莉[1] 王芸 孙庆 许波涛 张映飞 Cui Xiaoli;Wang Yun;Sun Qing;Xu Botao;Zhang Yingfei(Department of Anesthesia,Rugao Branch of Affiliated Hospital of Nantong University,Nantong 226500,China;Department of General Surgery,Rugao Branch of Affiliated Hospital of Nantong University,Nantong 226500,China)

机构地区：[1]南通大学附属医院如皋分院麻醉科,南通226500 [2]南通大学附属医院如皋分院普外科,南通226500

出　　处：《中国医师进修杂志》2024年第6期555-560,共6页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨超声引导下弓状韧带上腰方肌阻滞用于腹腔镜消化道肿瘤手术镇痛的有效性及安全性。方法回顾性选取2020年1月至2022年12月在南通大学附属医院如皋分院行腹腔镜消化道肿瘤手术的106例患者为研究对象,其中53例采用常规全身麻醉(对照组),53例全身麻醉前采用弓状韧带上腰方肌阻滞(观察组)。记录观察组阻滞后5、15 min感觉阻滞平面,比较两组不同时点血流动力学指标、应激指标及术后镇痛情况。结果观察组阻滞后5 min大部分患者可监测到T 8~L 1感觉阻滞平面,阻滞后15 min可达T 5~L 2感觉阻滞平面,阻滞比例为100.00%(53/53)。重复测量方差分析结果显示,心率(HR)、平均动脉压(MAP)在组间-时点交互作用比较差异有统计学意义(P<0.05);去甲肾上腺素(NE)、肾上腺素(E)、促肾上腺皮质激素(ACTH)、皮质醇(Cor)在组间-时点交互作用比较差异有统计学意义(P<0.05);静息和活动时视觉模拟量表(VAS)评分在组间-时点交互作用比较差异有统计学意义(P<0.05)。观察组术中丙泊酚用量、瑞芬太尼用量、经静脉患者自控镇痛(PCIA)有效按压次数、PCIA总按压次数均低于对照组[(1128.36±137.95)mg比(1415.18±153.24)mg、(1.47±0.49)mg比(2.76±0.74)mg、(4.25±0.87)次比(8.63±0.94)次、(10.27±1.25)次比(15.75±1.47)次],差异有统计学意义(P<0.05)。两组术后48 h内补救镇痛率比较差异无统计学意义(P>0.05)。观察组苏醒时间及首次下床、首次排气、住院时间均短于对照组[(4.75±0.57)min比(7.02±0.64)min、(11.65±1.47)h比(15.87±1.94)h、(14.79±2.12)h比(19.59±3.30)h、(4.78±0.72)d比(7.14±0.98)d],差异有统计学意义(P<0.05)。两组不良反应发生率比较差异无统计学意义(P>0.05)。结论超声引导下弓状韧带上腰方肌阻滞用于腹腔镜消化道肿瘤手术镇痛效果显著,可减少术中麻醉药维持剂量及术后镇痛药注射剂量,维持术中血流动力学稳定,减轻术�Objective To investigate the efficacy and safety of ultrasound-guided of lumbar square muscle block on the arcuate ligament in laparoscopic surgery for gastrointestinal tumors.Methods A retrospective study was conducted on 106 patients who underwent laparoscopic gastrointestinal tumor surgery in Rugao Branch of Affiliated Hospital of Nantong University from January 2020 to December 2022,53 patients(observation group)were given the ultrasound-guided of lumbar square muscle block on the arcuate ligament before general anesthesia,53 patients(control group)were given only general anesthesia.The sensory block planes were recorded at 5 min and 15 min after the block in the observation group,and the hemodynamic indexes,stress indexes at differences time points and postoperative analgesia were compared between the two groups.Results Most patients in the observation group could monitor the T 8-L 1 sensory block plane at 5 min after block,and the T 5-L 2 sensory block plane could be reached at 15 min after block,and the percentage of block was 100.00%(53/53).The results of repeated measurement variance analysis(ANOVA)showed that the intergroup-time point interaction of heart rate(HR)and mean arterial pressure(MAP)between the two groups had statistical differences(P<0.05);the intergroup-time point interaction of the levels of noradrenaline(NE),epinephrine(E),adrenocorticotropic hormone(ACTH),cortisol(Cor)between the two groups had statistical differences(P<0.05);the intergroup-time point interaction of the resting and active visual analog scale(VAS)scores between the two groups had statistical differences(P<0.05).The amount of propofol,remifentanil,the number of effective patient-controlled intravenous analgesia(PCIA)compressions,and the total number of PCIA compressions in the observation group were lower than those in the control group:(1128.36±137.95)mg vs.(1415.18±153.24)mg,(1.47±0.49)mg vs.(2.76±0.74)mg,(4.25±0.87)times vs.(8.63±0.94)times,(10.27±1.25)times vs.(15.75±1.47)times,there were statistical difference

关 键 词：腹腔镜 消化系统肿瘤 麻醉和镇痛 腰方肌阻滞 超声引导 弓状韧带 

分 类 号：R735[医药卫生—肿瘤] R614[医药卫生—临床医学]