无阿片类药物麻醉联合腰方肌阻滞在腹腔镜结直肠癌根治术中的应用效果  

Effect of opioid-free anesthesia combined with quadratus lumborum block in laparoscopic radical colorectal cancer resection

作　　者：周维 王凯 舒爱华 程传喜 陈小波 ZHOU Wei;WANG Kai;SHU Aihua;CHENG Chuanxi;CHEN Xiaobo(The First College of Clinical Medical Science,China Three Gorges University,Department of Anesthesiology,Yichang Central People s Hospital,Institute of Geriatric Anesthesiology,China Three Gorges University,Yichang 443000,China)

机构地区：[1]三峡大学第一临床医学院,宜昌市中心人民医院麻醉科,三峡大学老年麻醉医学研究所,443000

出　　处：《临床麻醉学杂志》2024年第9期938-943,共6页Journal of Clinical Anesthesiology

基　　金：宜昌市医疗卫生科研项目(A23-1-030)。

摘　　要：目的探讨无阿片类药物麻醉(OFA)联合腰方肌阻滞(QLB)在腹腔镜结直肠癌根治术中的应用效果。方法选择2023年3—12月行腹腔镜结直肠癌根治术患者70例,男49例,女21例,年龄18~75岁,BMI 18.5~28.0 kg/m^(2),ASAⅡ或Ⅲ级。采用随机数字表法将患者分为两组:无阿片组(OFA组)和常规阿片组(OA组),每组35例。OFA组在麻醉诱导前行超声引导下双侧后路QLB(每侧予0.25%罗哌卡因30 ml),麻醉诱导和维持采用艾司氯胺酮、利多卡因等OFA方案;OA组不行QLB,麻醉诱导和维持采用含阿片类药物方案。记录麻醉诱导前(T_(0))、气管插管后1 min(T_(1))、气腹建立前(T_(2))、气腹建立后1 min(T_(3))、手术开始后1 h(T_(4))、手术结束即刻(T_(5))、离室时(T 6)的HR和MAP。记录术中低血压、高血压、心动过缓、心动过速等不良反应的发生情况。记录拔管时间、PACU停留时间、离室时Steward苏醒评分和离室时VAS疼痛评分。记录术后6、12、24、48 h静息和活动时NRS评分。记录首次肛门排气时间、首次下床活动时间、术后住院时间、术后48 h内镇痛泵有效按压次数和补救镇痛例数。记录术后48 h内恶心呕吐、幻觉等不良反应的发生情况。结果与T_(0)时比较,两组T_(1)、T_(2)、T_(4)、T_(5)时MAP均明显降低(P<0.05);OFA组T_(1)时HR明显增快,T_(4)、T_(5)时HR明显减慢(P<0.05);OA组T_(1)—T_(5)时HR明显减慢(P<0.05)。与OA组比较,OFA组T_(1)—T_(3)时HR明显增快,T_(1)时MAP明显升高(P<0.05),OFA组拔管时间、PACU停留时间明显延长(P<0.05),离室时Steward苏醒评分明显降低(P<0.05),术后6、12、24、48 h活动时NRS评分明显降低(P<0.05),术后首次肛门排气时间、首次下床活动时间和术后住院时间明显缩短(P<0.05),镇痛泵有效按压次数明显减少(P<0.05),补救镇痛率、术中低血压和术后恶心呕吐发生率明显降低(P<0.05)。结论OFA联合QLB能够安全有效地完成腹腔镜结直肠癌根治术,麻醉Objective To explore the effect of opioid-free anesthesia(OFA)combined with quadratus lumborum block(QLB)in laparoscopic radical colorectal cancer resection.Methods Sventy patients were selected for undergoing laparoscopic radical colorectal cancer resection from March to December 2023,49 males and 21 females,aged 18-75 years,BMl 18.5-28.0 kg/m^(2),ASA physical statusⅡorⅢ.The patients were divided into two groups using random number table method:the OFA group(group OFA)and the conventional opioid anesthesia group(group OA),35 patients in each group.Group OFA underwent bilateral posterior QLB under ultrasound guidance before anesthesia induction(0.25%ropivacaine 30 ml on each side),and anesthesia induction and maintenance were performed using opioid-free anesthesia regimen.And group OA cannot undergo QLB,and anesthesia induction and maintenance were carried out using opioid containing regimen.The patient s HR and MAP were recorded before anesthesia induction(T_(0)),1 minute after endotracheal intubation(T_(1)),before pneumoperitoneum establishment(T_(2)),1 minute after pneumoperitoneum establishment(T_(3)),1 hour after surgery(T_(4)),the end of surgery(T_(5)),and leaving the operating room(T 6).The time from the patient s anesthetic discontinuation to extubation,the length of stay in the PACU,and the Steward and VAS pain scores when the patient leaves the operating room,which were recorded.NRS scores at rest and in the motor state 6,12,24,and 48 hours after surgery,time to first exhaust,time to first ambulation,and length of postoperative hospital stay,effective PCIA pressing times and use of additional analgesic drugs within 48 hours after the operation,and postoperative adverse reactions(nausea,vomiting,hallucinations)were also recorded.Results Compared with T_(0),the MAP of the two groups decreased significantly at T_(1),T_(2),T_(4),and T_(5)(P<0.05),the HR in group OFA increased significantly at T_(1) and slowed down at T_(4) and T_(5)(P<0.05),and the HR in group OA decreased significantly at T_(1)-T_(5)(P

关 键 词：无阿片类药物麻醉 腰方肌阻滞 结直肠癌 多模式镇痛 

分 类 号：R614[医药卫生—麻醉学] R735.34[医药卫生—外科学]