超声引导下腰方肌后路阻滞联合全身麻醉在腹腔镜全子宫切除术中的应用效果  

Application of ultrasound-guided posterior quadratus lumborum block combined with general anesthesia during laparoscopic total hysterectomy

作　　者：张春梅 张江川 陈运良 熊静静 ZHANG Chunmei;ZHANG Jiangchuan;CHEN Yunliang;XIONG Jingjing(West China Guangan Hospital of Sichuan University,Guang'an,Sichuan Province,638000)

机构地区：[1]四川大学华西广安医院,638000

出　　处：《中国计划生育学杂志》2025年第4期792-798,共7页Chinese Journal of Family Planning

基　　金：四川省医学会科研课题(S20054)。

摘　　要：目的:分析超声引导下腰方肌后路阻滞联合全身麻醉在腹腔镜全子宫切除术(LTH)中的应用效果。方法:选择2022年6月-2023年12月本院收治的拟行LTH患者135例,随机数表法分为全麻组(n=67,行全身麻醉)和联合组(n=68,行超声引导下腰方肌后路阻滞联合全身麻醉)。比较两组围麻醉期血流动力学指标心率(HR)、平均动脉压(MAP)经皮血氧饱和度(SPO_(2)),术后3h、12h、24h、48h疼痛评分[视觉模拟评分(VAS)]及舒适度评分(BCS评分)变化,统计麻醉苏醒与补救镇痛,比较术前、术后24h血清疼痛应激指标[神经肽Y(NPY)、皮质醇(Cor)和促肾上腺皮质激素(ACTH)]变化,并记录麻醉相关不良反应。结果:两组入室时~手术结束时的HR、MAP呈先降后升趋势,且联合组麻醉诱导时、气腹时和切除时HR和MAP水平与全麻组有差异(均P<0.05),SPO_(2)水平在组间、时间点及组间×时间点比较无差异(P>0.05);术后3 h、12 h、24 h、48 h两组静息、活动VAS评分及BCS评分均先升后降,且联合组各评分均低于全麻组(均P<0.05);联合组术后自主呼吸恢复时间(7.57±1.44min)、拔管时间(9.12±1.54min)、术后24 h内舒芬太尼使用量(30.64±5.11μg)及补救镇痛发生率(11.8%)均低于全麻组(8.46±1.56min、10.43±1.73min、36.28±5.78μg、25.4%),术后24 h两组血清NPY、Cor和ACTH水平均较术前提高但联合组低于全麻组,不良反应发生率联合组(7.4%)低于全麻组(19.4%)(均P<0.05)。结论:超声引导下腰方肌后路阻滞联合全身麻醉应用于LTH中镇痛效果明显,对患者血流动力学影响较小,可缩短麻醉苏醒,减少补救镇痛,提升舒适度,且不良反应少。Objective:To analyze the application effect of ultrasound-guided posterior quadratus lumborum block combined with general anesthesia during laparoscopic total hysterectomy(LTH).Methods:135 patients who were scheduled to receive LTH were selected and were divided into group A(67 patients with the general anesthesia during LTH)and group B(68 patients with the ultrasound-guided posterior quadratus lumborum block combined with general anesthesia during LTH)according to the random number table method from June 2022 to December 2023.The values of the hemodynamic indexes,such as heart rate(HR),mean arterial pressure(MAP)and transcutaneous oxygen saturation(SPO_(2)),the changes of the scores of the pain degree evaluated by visual analogue scale(VAS)and comfort evaluated by BCS scale at 3h,12h,24h and 48h after surgery of the patients were compared between the two groups.The anesthesia recovery and the remedial analgesia of the patients in the two groups were counted.The changes of the levels of the serum pain stress indexes,such as neuropeptide Y(NPY),cortisol(Cor)and adrenocorticotropic hormone(ACTH)of the patients before surgery and at 24 hours after surgery were compared between the two groups.The anesthesia-related adverse reactions of the patients in the two groups were recorded.Results:The values of HR and MAP of the patients in the two groups decreased first and then increased from the time of entering the operation room to the end of the operation.The values of HR and MAP of the patients in group B during anesthesia induction,during pneumoperitoneum and during resection were significantly different from those of the patients in group A(all P<0.05)There was no significant difference in the SPO2value of the patients between the two groups,among the different time points and among the different groups×time points(P>0.05).The VAS scores at rest and during activity and the BCS score of the patients in the two groups at 3h,12h,24hand 48hafter operation increased first and then decreased,and which of the patients in gr

关 键 词：腹腔镜全子宫切除术 超声引导 腰方肌后路阻滞 全身麻醉 应用效果 

分 类 号：R614[医药卫生—麻醉学]