超声引导下双侧后入路QLB复合静脉麻醉在全子宫切除术中的应用  

Application of Ultrasound-guided Bilateral Posterior Approach QLB Combined with Intravenous Anesthesia in Patients Underwent Total Hysterectomy

作　　者：郑贯峥 ZHENG Guanzheng(Luohe Central Hospital,Luohe,462000)

机构地区：[1]河南省漯河市中心医院,462000

出　　处：《实用癌症杂志》2025年第4期657-661,共5页The Practical Journal of Cancer

摘　　要：目的观察全子宫切除术中采用超声引导下双侧后入路腰方肌阻滞(QLB)复合静脉麻醉的效果。方法该研究为一项前瞻性研究。将2021年1月至2023年12月医院收治的行全子宫切除术的96例患者随机分为2组(研究组、对照组,均48例)。对照组行舒芬太尼联合丙泊酚静脉麻醉,研究组实施超声引导下双侧后入路QLB复合静脉麻醉。比较2组患者在麻醉诱导前30 min(T_(0))、切皮时(T_(1))、术毕时(T_(2))应激反应指标[肾上腺素(E)、去甲肾上腺素(NE)]、血流动力学指标[心率(HR)、平均动脉压(MAP)];比较2组麻醉苏醒后6 h、12 h、24 h静息及运动时疼痛程度[采用视觉模拟评分法(VAS)评估];统计2组术后72 h内麻醉不良反应发生情况。结果整体分析2组应激反应:组间比较、时点间比较及交互作用均有差异(P<0.05),2组T_(1)、T_(2)时E、NE均较T_(0)升高,T_(2)较T_(1)升高(P<0.05);组间T_(0)时点比较无差异(P>0.05),研究组T_(1)、T_(2)时各指标水平均低于对照组(P<0.05)。整体分析血流动力学:组间比较、时点间比较及交互作用均有差异(P<0.05),组内比较,2组T_(1)、T_(2)时HR、MAP均较T_(0)时降低,对照组T_(2)较T_(1)升高(P<0.05),研究组T_(2)、T_(1)时HR、MAP比较无差异(P>0.05);组间比较,2组T_(0)时HR、MAP比较无差异(P>0.05),研究组T_(1)、T_(2)时HR、MAP均高于对照组(P<0.05)。整体分析2组术后疼痛(VAS评分):组间比较、时点间比较及交互作用有差异(P<0.05),组内比较,2组麻醉苏醒后12 h、24 h静息及运动状态下VAS评分均较麻醉苏醒后6 h升高,麻醉苏醒后24 h评分较麻醉苏醒后12 h升高(P<0.05);组间比较,研究组麻醉苏醒后6 h、12 h、24 h静息及运动时VAS评分均低于对照组(P<0.05)。与对照组比较,术后72 h内研究组麻醉不良反应总发生率更低(P<0.05)。结论全子宫切除术采用超声引导下双侧后入路QLB复合传统静脉麻醉,有助于减轻患者应激反应,稳定血流动力Objective To observe the application effect of ultrasound-guided bilateral posterior approach quadratus lumborum block(QLB)combined with intravenous anesthesia in patients underwent total hysterectomy.Methods This study was a prospective study,and 96 patients with total hysterectomy were included in this study.The patients were randomly divided into 2 groups(study group,control group,48 cases).The control group received intravenous anesthesia with sufentanil combined with propofol,while the study group received bilateral posterior QLB combined intravenous anesthesia under ultrasound guidance.The stress response indexes[epinephrine(E),norepinephrine(NE)]and hemodynamic indexes[heart rate(HR),mean arterial pressure(MAP)]were compared between the 2 groups at 30 min before anesthesia induction(T_(0)),at skin incision(T_(1))and at the end of operation(T_(2)).The degree of pain at rest and during exercise at 6 h,12 h and 24 h after anesthesia recovery was compared between the 2 groups[assessed by visual analogue scale(VAS)].The incidence of adverse reactions of anesthesia within 72 hours after operation in the two groups was statistically analyzed.Results There were differences in stress response between the 2 groups in terms of inter group comparison,time point comparison,and interaction(P<0.05).E and NE were higher than T_(0) in T_(1) and T_(2),while T_(2) was higher than T_(1)(P<0.05).There was no significant difference at T_(0) time point between groups(P>0.05).The levels of various indicators in the study group at T_(1) and T_(2) were lower than those in the control group(P<0.05).Overall analysis of hemodynamics:There were differences in inter group comparison,time point comparison,and interaction(P<0.05).Within group comparison,HR and MAP decreased in both groups at T_(1) and T_(2) compared to T_(0),while T_(2) in the control group increased compared to T_(1)(P<0.05).There was no difference in HR and MAP between the study group at T_(2) and T_(1)(P>0.05).Inter group comparison showed no significant difference in

关 键 词：全子宫切除术 静脉麻醉 超声引导 腰方肌阻滞 双侧后入路 镇痛 

分 类 号：R737.33[医药卫生—肿瘤]