超声引导下改良前路腰方肌阻滞对妇科肿瘤手术患者术后镇痛效果的研究  

The effect of ultrasound-guided modified anterior quadrate block on postoperative analgesia in gynecological tumor patients

作　　者：付国辉 光文辉[2] 张灵敏[3] 彭春潮[2] 任嵘 何宗钊[2] FU Guohui;GUANG Wenhui;ZHANG Lingmin;PENG Chunchao;REN Rong;HE Zongzhao(Graduate School of Qinghai University,Qinghai Xining 810016,China;Department of Anesthesiology,Qinghai Provincial People's Hospital,Qinghai Xining 810007,China;Department of Anesthesiology,the First Affiliated Hospital of Xi'an Jiaotong University,Shaanxi Xi'an 710061,China)

机构地区：[1]青海大学研究生院,青海西宁810016 [2]青海省人民医院麻醉科,青海西宁810007 [3]西安交通大学第一附属医院麻醉科,陕西西安710061

出　　处：《现代肿瘤医学》2025年第3期453-458,共6页Journal of Modern Oncology

基　　金：2023年青海省“昆仑英才·高层次卫生健康人才”项目(青人才字[2023]9号,青人才字[2023]10号)。

摘　　要：目的:评价超声引导下改良前路腰方肌阻滞在妇科肿瘤手术中的镇痛效果。方法:选择择期行腔镜妇科肿瘤手术患者94例,随机分为两组:Q组(改良前路腰方肌阻滞组,n=47)和C组(不行腰方肌阻滞组,n=47)。麻醉诱导前,Q组在超声引导下行双侧改良前路腰方肌阻滞,每侧均给予0.33%罗哌卡因20 mL。术毕两组均行自控静脉镇痛(patient controlled intravenous analgesia,PCIA)。记录主要观察指标:术后2 h、6 h、24 h、48 h静息和运动时VAS评分;术后48 h内补救镇痛情况;次要指标:围术期丙泊酚和阿片类药物用量;术后2 h、6 h、24 h、48 h BCS评分;术后首次下床活动时间、肛门排气时间、进食时间、术后住院时间,术后皮肤瘙痒、恶心呕吐等不良反应发生情况。结果:术后48 h Q组补救镇痛药需求小于C组(P<0.05);Q组术后2 h、6 h、24 h静息和运动时VAS评分低于C组(P<0.05),48 h静息和运动时VAS评分差异无统计学意义;2 h、6 h、24 h、48 h BCS评分高于C组(P<0.05);Q组围术期阿片类药物用量明显少于C组(P<0.05);两组丙泊酚用量差异无统计学意义;Q组首次下床活动时间、肛门排气时间、进食时间明显短于C组(P<0.05);两组住院时间差异无统计学意义;Q组术后恶心、呕吐、皮肤瘙痒的发生率显著低于C组(P<0.05)。结论:超声引导下改良前路腰方肌阻滞可减少妇科肿瘤手术患者术后镇痛药物需求,降低疼痛评分,促进患者术后恢复,减少阿片类药物不良反应。Objective:To evaluate the analgesic effect of ultrasound-guided modified anterior quadrate block in gynecological tumor surgery.Methods:A total of 94 patients undergoing elective endoscopic surgery for gynecologic tumors were randomly divided into two groups:Group Q(modified anterior quadrate block group,n=47) and group C(group without quadrate block group,n=47).Before anesthesia induction,group Q was given 0.33% ropivacaine 20mL on each side of bilateral improved anterior quadrate block under ultrasound guidance.After the operation,both groups underwent controlled intravenous analgesia(PCI A).The main outcome measures were recorded:Resting and exercise VAS scores at 2 h,6 h,24 h and 48 h after surgery.Relief of analgesia within 48 h after surgery.Secondary indexes:Perioperative propofol and opioid dosage.2 h,6 h,24 h,48 h BCS score after surgery.Postoperative first time of getting out of bed,anal exhaust time,eating time,postoperative hospitalization time,postoperative skin itching,nausea and vomiting and other adverse reactions.Results:The demand for analgesics in 48 h Q group was lower than that in C group(P <0.05).The VAS scores at rest and exercise in Q group at 2 h,6 h and 24 h after operation were lower than those of C group(P <0.05).There was no significant difference in VAS scores at rest and exercise at 48 h.BCS scores at 2 h,6 h,24 h and 48 h were higher than those in C group(P <0.05).Perioperative opioid consumption in group Q was significantly lower than that in group C(P <0.05).There was no significant difference in the dosage of propofol between the two groups.The time of getting out of bed for the first time,anal exhaust time and feeding time in group Q were significantly shorter than those in group C(P <0.05).There was no significant difference in length of stay between the two groups.The incidence of postoperative nausea,vomiting and pruritus in group Q was significantly lower than that in group C(P <0.05).Conclusion:Ultrasound-guided modified anterior quadrate block can reduce postoperative ana

关 键 词：妇科肿瘤手术 改良前路腰方肌阻滞 术后疼痛 VAS评分 

分 类 号：R737.3[医药卫生—肿瘤]