腰方肌阻滞麻醉对女性尿毒症患者腹膜透析置管术中血气指标及术后恢复的影响  

Effect of quadrate lumbomuscle block anesthesia on blood gas indexes and postoperative recovery in female uremic patients undergoing peritoneal dialysis catheterization

作　　者：安美霖 马东风 郭桂香 张磊 李煜 田釜宇 黄新利[1] An Meilin;Ma Dongfeng;Guo Guixiang;Zhang Lei;Li Yu;Tian Fuyu;Huang Xinli(Department of Anesthesiology,Langfang People's Hospital,Langfang 065000,Hebei,China)

机构地区：[1]廊坊市人民医院麻醉科,河北廊坊065000

出　　处：《中国中西医结合急救杂志》2024年第4期451-454,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：河北省廊坊市科技研究与发展计划项目(2023013229)。

摘　　要：目的观察腰方肌阻滞(QLB)麻醉对女性尿毒症患者腹膜透析置管术中血气指标及术后恢复的影响.方法选取2021年1月至2023年12月廊坊市人民医院收治的70例行腹膜透析置管术女性尿毒症患者作为研究对象.按随机数字表法将患者分为对照组和研究组,每组35例.对照组给予常规局部浸润麻醉方案,研究组采用QLB麻醉方案.观察两组患者不同间点平均动脉压(MAP)、心率(HR)、血气指标[脉搏血氧饱和度(SpO_(2))、动脉血二氧化碳分压(PaCO_(2))]、数字评分量表(NRS)评分、术前和术后24h疼痛因子[5-羟色胺(5-HT)、P物质(SP)、去甲肾上腺素(NE)]水平的变化、术后恢复指标(首次下床时间、首次排气时间、住院时间)及不良反应发生情况.结果两组入室时MAP、HR、血气指标及NRS评分比较差异均无统计学意义.研究组切皮时、腹直肌分离时、置管时、缝合时、出室时MAP、HR、PaCO_(2)均明显低于对照组,SpO_(2)均明显高于对照组,切皮时、腹直肌分离时、置管时、缝合时NRS评分均明显低于对照组(均P<0.05).两组术前5-HT、SP、NE水平比较差异无统计学意义,术后24h均较术前明显升高,但研究组5-HT、SP、NE水平均低于对照组(均P<0.05).研究组首次下床时间、首次排气时间、住院时间均较对照组明显缩短,不良反应发生率也明显低于对照组(均P<0.05).结论QLB能减少女性尿毒症患者腹膜透析置管术中MAP、HR及血气指标波动,缓解患者术后疼痛,降低疼痛因子水平,并减少不良反应发生,对促进患者术后恢复有较好的效果.Objective To observe the effect of quadratus lumborum block(QLB)anesthesia on intraoperative blood gas indexes and postoperative recovery in female uremic patients with peritoneal dialysis catheterization.Methods A total of 70 female uremic patients with peritoneal dialysis catheterization admitted to Langfang People's Hospital from January 2021 to December 2023 were selected as the research objects.According to the random number table method,they were divided into the control group and the study group,with 35 cases in each group.The control group was given conventional local infiltration anesthesia,whereas the study group was given QLB anesthesia.The changes of mean arterial pressure(MAP),heart rate(HR),blood gas indexes[pulse oxygen saturation(SpO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))]and numeric rating scale(NRS)score,at different points pain factors[5-hydroxytryptamine(5-HT),substance P(SP),norepinephrine(NE)]before operation and 24 hours after operation,postoperative recovery(time to get out of bed for the first time,exhaust time,length of hospital stay)and adverse reactions were observed in the two groups.Results There was no significant difference in MAP,HR,blood gas index and NRS score between the two groups at the admission.The MAP,HR,PaCO_(2)in the study group were significantly lower than those in the control group during skin incision,rectus abdominis separation,catheterization,suture,and leaving the room,and SpO_(2)was significantly higher than that in the control group,and NRS score in the study group were significantly lower than those in the control group during skin incision,rectus abdominis separation,catheterization,suture(all P<0.05).There was no significant difference in the levels of 5-HT,SP and NE between the two groups before operation,but the levels of 5-HT,SP and NE at 24 hours after operation were significantly higher than those before operation,but the levels of 5-HT,SP and NE in the study group were lower than those in the control group.The first ambulation time,e

关 键 词：腰方肌阻滞 女性 尿毒症 腹膜透析置管术 血气指标 术后恢复 

分 类 号：R69[医药卫生—泌尿科学]