腹腔镜全子宫切除术中经弓状韧带上腰方肌阻滞镇痛效果  

Analgesic Effect of Laparoscopic Total Hysterectomy via Superior Arcuate Ligament Quadrate Muscle Block

作　　者：黄亚飞 陈桂丽 周伟亚 HUANG Ya-fei;CHEN Gui-li;ZHOU Wei-ya(Department of Anesthesiology,Xiangcheng Hospital of Traditional Chinese Medicine,Xiangcheng 466200,Henan Province,China)

机构地区：[1]项城市中医院麻醉科,河南项城466200

出　　处：《罕少疾病杂志》2025年第2期154-156,共3页Journal of Rare and Uncommon Diseases

基　　金：河南医学科技攻关计划联合共建项目(LHGJ20202146)。

摘　　要：目的 探讨腹腔镜全子宫切除术中经弓状韧带上腰方肌阻滞镇痛效果。方法 严格执行纳排标准后前瞻性选取我院2021.02至2022.08期间行腹腔镜全子宫切除术的91例患者为研究对象,将所纳入研究对象按照随机数字表法分为两组,其中TAPB组45例采用经腹横肌平面阻滞,QLB-LSAL组46例采用经弓状韧带上腰方肌阻滞,分析两组患者麻醉情况及术后恢复指标、疼痛及镇静程度、镇痛效果、不良反应发生率。结果 QLB-LSAL组阻滞操作时间、起效时间、术后苏醒时间、首次排气时间及离床时间、住院时间均短于TAPB组(P<0.05);QLB-LSAL组术后2h、8h、12h、24h VAS评分均低于TAPB组,术后2h TAPB组Ramsay镇静评分低于QLB-LSAL组(P<0.05),术后8h、12h、24h两组Ramsay镇静评分对比差异无统计学意义(P>0.05);QLB-LSAL组舒芬太尼用量、镇痛泵按压总次数均少于TAPB组,首次按压时间长于TAPB组(P<0.05);两组的不良反应发生率对比差异无统计学意义(P>0.05)。结论 将超声引导下经弓状韧带上腰方肌阻滞应用于腹腔镜全子宫切除术中不仅可减轻患者术后疼痛程度,提高镇痛效果,而且能缩短患者住院时间,进而促进患者术后恢复。Objective To investigate the analgesic effect of transcatheter quadrate musculi lumbosus superior arcuate ligament block during laparoscopic total hysterectomy.Methods A total of 91 patients who underwent laparoscopic total hysterectomy in our hospital during February 2021 to August 2022 were prospectively selected as study subjects after strict implementation of the exclusion criteria,and the included subjects were divided into two groups according to the random number table method.45 patients in the TAPB group underwent transtransverse muscle plane block.Forty-six patients in QLB-LSAL group were blocked by the quadrate musculi lumbosa superior arcuate ligament.Anesthesia,postoperative recovery indexes,pain and sedation degree,analgesic effect,and incidence of adverse reactions were analyzed.Results The time of block operation,onset time,postoperative recovery time,first exhaust time,time out of bed and hospital stay in QLB-LSAL group were shorter than those in TAPB group(P<0.05).The scores of QLB-LSAL group at 2h,8h,12h and 24hVAS were lower than those of TAPB group.The scores of Ramsay sedation in 2hTAPB group were lower than those in QLB-LSAL group(P<0.05).There was no significant difference in the scores of Ramsay sedation in 8h,12h and 24h between the two groups(P>0.05).The dosage of sufentanil and the total number of analgesic pump compressions in QLB-LSAL group were lower than those in TAPB group,and the first compression time was longer than that in TAPB group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion The application of ultrasound-guided transarcuate ligamentum superior quadrate block in laparoscopic total hysterectomy can not only reduce postoperative pain,improve analgesic effect,but also shorten hospital stay and promote postoperative recovery of patients.

关 键 词：腹腔镜 全子宫切除术 弓状韧带上腰方肌阻滞 镇痛效果 

分 类 号：R713.42[医药卫生—妇产科学]