超声引导下不同平面阻滞联合全麻在腹腔镜胃癌根治术患者中的应用及对血流动力学的影响  

Application of different plane block combined with general anesthesia under ultrasound guidance in patients undergoing laparoscopic radical gastrectomy for gastric cancer and its influence on hemodynamics

作　　者：汪华娟 邱荣恩 徐玲 刘珊 吴望晟 Wang Huajuan;Qiu Rongen;Xu Ling;Liu Shan;Wu Wangsheng(Department of Anesthesiology,Quzhou Hospital Affiliated to Wenzhou Medical University(Quzhou People′s Hospital),Quzhou 324000,China)

机构地区：[1]温州医科大学附属衢州医院(衢州市人民医院)麻醉科,衢州324000

出　　处：《中国医师杂志》2025年第1期71-75,80,共6页Journal of Chinese Physician

基　　金：中国红十字基金会医学赋能公益专项基金镇痛行动临床科研项目(2023-627);衢州市科技计划项目(2023K147)。

摘　　要：目的比较在腹腔镜胃癌根治术中应用全麻联合超声引导下不同平面阻滞的效果。方法选取2022年6月—2023年9月温州医科大学附属衢州医院收治的160例胃癌患者,采用随机数字表法分为对照组和观察组,每组80例。入组者均行全麻,在此基础上对照组联合超声引导下竖脊肌平面阻滞(ESPB),观察组联合超声引导下腰方肌阻滞(QLB),对比两组血流动力学、应激反应、疼痛程度、术后恢复时间、不良事件及麻醉恢复质量。结果观察组切皮时(T_(1))、切除病灶时(T_(2))时刻平均动脉压(MAP)水平低于对照组,T_(1)、T_(2)及术毕(T_(3))时刻心率(HR)低于对照组(均P<0.05);观察组麻醉诱导后、切皮后10 min、术毕及术后24 h皮质醇(Cor)、白细胞介素-6(IL-6)水平低于对照组(均P<0.05);观察组术后2、6、12、24 h及48 h静息、运动状态下疼痛视觉模拟量表(VAS)评分低于对照组(均P<0.05);观察组苏醒、下床活动及肛门排气时间短于对照组(均P<0.05);观察组不良事件发生率与对照组差异无统计学意义[11.25%(9/80)vs 16.25%(13/80),P>0.05];观察组40项恢复质量评分量表(QoR-40)各项评分及总分高于对照组(均P<0.05)。结论腹腔镜胃癌根治术中应用超声引导下QLB联合全麻,相较于超声引导下ESPB联合全麻,可取得更好的围手术期镇痛效果,有利于稳定患者血流动力学,减轻机体应激反应,且患者术后恢复时间更短,可提高患者麻醉恢复质量。Objective To compare the effect of different plane block under general anesthesia combined with ultrasound guidance in laparoscopic radical gastrectomy for gastric cancer.MethodsA total of 160 patients with gastric cancer admitted to the Quzhou Hospital Affiliated to Wenzhou Medical University from June 2022 to September 2023 were selected and divided into control group and observation group by random number table method,with 80 cases in each group.All participants underwent general anesthesia.On this basis,the control group combined with ultrasonic-guided vertical spinal plane block(ESPB).The observation group was combined with ultrasound-guided quadratus lumbar block(QLB).The hemodynamics,stress response,pain degree,postoperative recovery time,adverse events and quality of recovery from anesthesia were compared between the two groups.ResultsThe mean arterial pressure(MAP)level at the time of skin incision(T_(1))and lesion resection(T_(2))in observation group was lower than that in control group,and the heart rate(HR)at the time of T_(1),T_(2) and after surgery(T_(3))was lower than that in control group(all P<0.05).The levels of cortisol(Cor)and interleukin-6(IL-6)in the observation group were lower than those in control group after anesthesia induction,10 min after skin resection,24 h after surgery(all P<0.05).The scores of Visual Analogue Scale(VAS)at rest and exercise at 2,6,12,24 and 48 h in the observation group were lower than those in the control group(all P<0.05).The time of awakening,getting out of bed and anal exhaust in the observation group was shorter than that in the control group(all P<0.05).There was no significant difference in the incidence of adverse events between the observation group and the control group[11.25%(9/80)vs 16.25%(13/80),P>0.05].The scores and total scores of 40-item Quality of Recovery Score(QoR-40)in the observation group were higher than those in the control group(all P<0.05).ConclusionsCompared with ultrasound-guided ESPB combined with general anesthesia,the application of

关 键 词：胃肿瘤 腹腔镜检查 神经传导阻滞 腰方肌阻滞 竖脊肌平面阻滞 

分 类 号：R735.2[医药卫生—肿瘤]