超声造影评估腰方肌阻滞局麻药扩散的临床研究  

Clinical Study of Contrast-Enhanced Ultrasound to Evaluate Local Anesthetic Diffusion in Quadrate Lumbomuscle Block

作　　者：张龙云 周炜[2] 赵超[2] 董亮[2] 江凌[1] 崔立刚[1] 邓莹[3] Zhang Longyun;Zhou Wei;Zhao Chao;Dong Liang;Jiang Ling;Cui Ligang;Deng Ying(Department of Ultrasound Medicine,Peking University Third Hospital,Beijing 100191,China;Department of Ultrasound,Shengli Oilfield Central Hospital,Dongying,Shandong 257000,China;Department of Anesthesiology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院超声医学科,北京市100191 [2]胜利油田中心医院超声检查科,山东省东营市257000 [3]北京大学第三医院麻醉科,北京市100191 [4]胜利油田中心医院

出　　处：《中国超声医学杂志》2024年第9期1058-1061,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的应用超声造影评估腰方肌阻滞(QLB)局麻药的扩散,同时比较不同入路药液扩散范围。方法选择30位腹腔镜盆腔手术患者,按照腰方肌不同入路阻滞,随机分为腰方肌外侧阻滞组(QLB1,n=20)、腰方肌后路阻滞组(QLB2,n=20)、腰方肌前路阻滞组(QLB3,n=20)。于全身麻醉前行超声引导下腰方肌阻滞,阻滞药物均为0.5%罗哌卡因+超声造影剂的混合液20 mL,注射后即刻利用超声造影模式观察注射液扩散,并比较3种入路的药物扩散范围。结果在QLB期间和之后,含有超声造影剂的注射液显示为明显的高增强,边界清晰可见,测量矢状面、横断面(上下、左右径)最大扩散范围。3组间结果有统计学意义,其中QLB3组头尾方向扩散范围明显大于QLB1组和QLB2组。结论超声造影应用于腰方肌阻滞中,可以清晰观察到药液弥散,实时准确评估药液扩散范围,拓宽了超声造影剂的应用范围,为临床提供了一个全新的神经阻滞评估手段和全新的教学方向。Objective To evaluate the diffusion of local anesthetic agents in quadrate lumbomuscle block(QLB)by contrast-enhanced ultrasound and to evaluate the difference in the diffusion range among different approaches.Methods Thirty patients undergoing laparoscopic pelvic surgery were randomly divided into three groups according to different approaches of quadrate block:the lateral quadrate block group(QLB1,n=20),the posterior quadrate block group(QLB2,n=20)and the anterior quadrate block group(QLB3,n=20).Before anesthesia,lumboquadrate block was performed,and 20 mL of mixture containing 0.5%ropivacaine plus ultrasonic contrast agent was injected into each side.The diffusion of injection was observed immediately after injection by contra-ultrasound mode,and the diffusion ranges of the three injection routes were analyzed.Results During and after QLB,the injection containing ultrasound contrast agent showed obviously high enhancement,the boundary was clearly visible,but the surrounding tissue was not enhanced,and the injection was in sharp contrast with the surrounding tissue.The maximum diffusion range of sagittal plane and cross section(upper and lower diameter,left and right diameter)was measured.There was a statistically significant difference in the results among the three groups,with the QLB3 group having a significantly larger head and tail diffusion range than the QLB1 and QLB2 groups.Conclusions The application of contrast-enhanced ultrasound in quadrate lumbomuscle block can clearly observe the diffusion of the drug liquid,accurately e-valuate the diffusion range of the drug liquid in real time,broaden the application range of ultrasound contrast agent,and provide a new method for clinical nerve block evaluation and a new teaching direction.

关 键 词：超声造影 腰方肌阻滞 药物扩散 区域阻滞 

分 类 号：R445.1[医药卫生—影像医学与核医学] R614[医药卫生—诊断学]