超声引导下双侧腰方肌阻滞、腹横肌平面阻滞对妇科腔镜手术患者术后镇痛效果比较  

Comparison of postoperative analgesia effect of ultrasound-guided bilateral quadrate lumbomuscle block and transverse abdominal muscle plane block in the patients undergoing gynecological endoscopic surgery

作　　者：张春燕[1] 李焕丽 刘晶晶 刘曙光[1] ZHANG Chun-yan;LI Huan-li;LIU Jing-jing;LIU Shu-guang(Department of Anesthesiology,Zhoukou Central Hospital,Zhoukou 466000,Henan,CHINA)

机构地区：[1]周口市中心医院麻醉科,河南周口466000

出　　处：《海南医学》2024年第18期2633-2637,共5页Hainan Medical Journal

基　　金：2021年度河南省医学科技攻关计划联合共建项目(编号:LHGJ20211395)。

摘　　要：目的比较超声引导下双侧腰方肌阻滞(QLB)、腹横肌平面阻滞(TAPB)对妇科腔镜手术患者的术后镇痛效果。方法选取2022年1月至2023年12月周口市中心医院收治的74例拟行妇科腔镜手术患者作为研究对象,按随机抽签法分为TAPB组和QLB组各37例。QLB组患者采用超声引导下双侧QLB复合全麻,TAPB组采用超声引导下TAPB复合全麻。比较两组患者术前和术后3 h、12 h、24 h的应激反应指标[皮质醇、肾上腺素(EP)、去甲肾上腺素(NE)]和术后3 h、6 h、24 h、48 h疼痛视觉模拟法(VAS)评分,同时比较两组患者的镇痛泵使用情况及术后不良反应发生率。结果术后3 h、12 h及24 h,QLB组患者的EP水平分别为(102.73±19.82)μg/L、(117.82±20.35)μg/L、(92.74±17.12)μg/L,皮质醇水平分别为(254.37±26.31)μg/L、(292.84±27.59)μg/L、(247.42±30.25)μg/L、NE水平分别为(402.36±29.83)μg/L、(468.94±30.12)μg/L、(379.25±30.41)μg/L,明显低于TAPB组同时间点EP[(127.66±20.45)μg/L、(143.82±24.94)μg/L、(103.25±15.69)μg/L]、皮质醇[(289.63±26.94)μg/L、(318.62±32.45)μg/L、(264.83±28.49)μg/L]、NE[(498.25±32.45)μg/L、(576.88±25.64)μg/L、(402.37±32.11)μg/L],差异均有统计学意义(P<0.05);QLB组患者术后6 h、12 h、24 h的疼痛VAS评分分别为(3.20±0.63)分、(2.53±0.38)分、(1.82±0.39)分,明显低于TAPB组的(4.69±0.50)分、(3.52±0.40)分、(2.90±0.34)分,差异均有统计学意义(P<0.05);术后QLB组患者的镇痛泵首次使用时间为(11.54±2.13)h,明显长于TAPB组的(7.38±1.68)h,按压次数、舒芬太尼总用量分别为(5.14±1.36)次、(105.43±7.42)μg,明显少于TAPB组的(7.89±1.67)次、(121.23±9.54)μg,差异均有统计学意义(P<0.05);QLB组患者的不良反应总发生率为5.41%,明显低于TAPB组的21.62%,差异有统计学意义(P<0.05)。结论超声引导下双侧QLB用于妇科腔镜手术中可减轻患者术后应激反应和疼痛程度,减少镇痛泵中阿片类药物用量,减少麻醉Objective To compare the postoperative analgesia effect of ultrasoundguided bilateral quadrate lumbomuscle block(QLB)and transverse abdominal muscle plane block(TAPB)in the patients undergoing gynecological endoscopic surgery.Methods A total of 74 patients who were scheduled to undergo gynecological laparoscopic surgery at Zhoukou Central Hospital from January 2022 to December 2023 were selected as the research subjects and randomly divided into TAPB group and QLB group,with 37 patients in each group.Patients in the QLB group received ultrasoundguided bilateral QLB combined with general anesthesia,while those in the TAPB group received ultrasoundguided TAPB combined with general anesthesia.The stress response indicators(cortisol,adrenaline[EP],norepinephrine[NE])and VisualAnalogue Scale(VAS)scores were compared between the two groups before surgery and at 3 h,12 h,and 24 h after surgery,as well as the use of pain pumps and incidence of adverse reactions after surgery.Results At 3 h,12 h,and 24 h after operation,EP levels were(102.73±19.82)μg/L,(117.82±20.35)μg/L,and(92.74±17.12)μg/L in QLB group versus(127.66±20.45)μg/L,(143.82±24.94)μg/L,and(103.25±15.69)μg/L in TAPB group,respectively;cortisol levels were(254.37±26.31)μg/L,(292.84±27.59)μg/L,and(247.42±30.25)μg/L versus(289.63±26.94)μg/L,(318.62±32.45)μg/L,and(264.83±28.49)μg/L,respectively;NE levels were(402.36±29.83)μg/L,(468.94±30.12)μg/L,and(379.25±30.41)μg/L versus(498.25±32.45)μg/L,(576.88±25.64)μg/L,and(402.37±32.11)μg/L,respectively;the differences were statistically significant(P<0.05).At 6 h,12 h,and 24 h after operation,the VAS scores in QLB group were(3.20±0.63)points,(2.53±0.38)points,and(1.82±0.39)points,respectively,which were significantly lower than(4.69±0.50)points,(3.52±0.40)points,and(2.90±0.34)points in the TAPB group(P<0.05).The duration for first use of the analgesic pump in the QLB group was(11.54±2.13)h,which was significantly longer than(7.38±1.68)h in the TAPB group;the times of compression

关 键 词：妇科腔镜手术 腰方肌阻滞 腹横肌平面阻滞 应激反应 不良反应 

分 类 号：R713[医药卫生—妇产科学]