腰方肌阻滞对老年腹腔镜手术患者肾功能的影响  

The Effects of Quadratus Lumborum Block on Renal Function in Elderly Patients Undergoing Laparoscopic Surgery

作　　者：陈学良 岳修勤[2] CHEN Xue-liang;YUE Xiu-qin(Department of Anesthesia and Surgery,the First Affiliated Hospital of Henan University of Technology,Jiaozuo 454000,China;Department of Anesthesia and Perioperative Medicine,the First Affiliated Hospital of Xinxiang Medical College,Xinxiang 453100,China)

机构地区：[1]河南理工大学第一附属医院麻醉手术部,河南焦作454000 [2]新乡医学院第一附属医院麻醉与围术期医学科,河南新乡453100

出　　处：《实用临床医学（江西）》2024年第5期43-47,F0004,共6页Practical Clinical Medicine

基　　金：焦作市科技计划项目(202223014)。

摘　　要：目的探究腰方肌阻滞对老年腹腔镜手术患者肾功能的影响。方法选取老年腹腔镜手术患者160为研究对象,按照随机数字表法分为观察组(n=80)和对照组(n=80)。2组均应用全身麻醉联合超声引导下神经阻滞技术,其中观察组患者应用腰方肌阻滞,对照组应用腹横肌平面阻滞。对比2组患者肾功能指标[术前(T0)、麻醉前(T1)、麻醉后60 min(T2)、手术结束即刻(T3)、术后1 d(T4)、术后2 d(T5)、术后3 d(T6)的血β2-微球蛋白(β2-MG)和尿β2-MG水平],手术指标(术中输液量、输血量、出血量和尿量),麻醉药物(瑞芬太尼、丙泊酚、苯磺顺阿曲库铵)使用量,以及镇痛效果(T3、T4、T5、T6时期的静息和运动疼痛评分)。结果观察组患者T3、T4、T5、T6时期的血β2-MG水平均低于对照组(P<0.05或P<0.001),T2、T3、T4、T5、T6时期的尿β2-MG水平均低于对照组(P<0.05或P<0.01或P<0.001)。观察组患者瑞芬太尼和丙泊酚使用量低于对照组(P<0.01,P<0.001)。观察组患者T4、T6时期的静息疼痛评分,以及T4、T5、T6时期的运动疼痛评分均低于对照组(P<0.05或P<0.01或P<0.001)。2组患者术中输液量、输血量、出血量和尿量比较差异无统计学意义(P>0.05)。结论腰方肌阻滞能避免老年腹腔镜手术患者的肾功能受损,减少麻醉药物使用剂量,减轻术后疼痛,应用效果显著。Objective To investigate the effects of quadratus lumborum block on renal function in elderly patients undergoing laparoscopic surgery.Methods A total of 160 elderly patients undergoing laparoscopic surgery were selected as the study subjects and divided into an observation group(n=80)and a control group(n=80)according to the random number table method.Both groups received general anesthesia combined with ultrasound-guided nerve block technique,wherein the observation group underwent quadratus lumborum block,while the control group underwent transversus abdominis plane block.The renal function indicators[bloodβ2-microglobulin(β2-MG)and urineβ2-MG levels at preoperative(T0),before anesthesia(T1),60 minutes after anesthesia(T2),immediately after surgery(T3),1 day postoperatively(T4),2 days postoperatively(T5),and 3 days postoperatively(T6)],surgical indicators(intraoperative infusion volume,blood transfusion volume,bleeding volume,and urine volume),anesthetic drug(remifentanil,propofol,phenylsulfonylureate)usage,and analgesic effects(resting and exercise pain scores at T3,T4,T5,and T6)were compared between the 2 groups.Results The bloodβ2-MG levels in the observation group were lower than those in the control group during T3,T4,T5,and T6 periods(P<0.05 or P<0.001),and the urineβ2-MG levels during T2,T3,T4,T5,and T6 periods were lower than those in the control group(P<0.05 or P<0.01 or P<0.001).The usage of remifentanil and propofol in the observation group was lower than that in the control group(P<0.01,P<0.001).The resting pain scores during T4 and T6,as well as the exercise pain scores during T4,T5,and T6,were all lower in the observation group than in the control group(P<0.05 or P<0.01 or P<0.001).There was no statistically significant difference in intraoperative infusion volume,blood transfusion volume,bleeding volume,and urine volume between the 2 groups of patients(P>0.05).Conclusion Quadratus lumborum block can effectively prevent renal function impairment in elderly patients undergoing laparoscopic su

关 键 词：腹腔镜手术 老年 腰方肌阻滞 肾功能 

分 类 号：R614.4[医药卫生—麻醉学]