弓状韧带上腰方肌阻滞在腹腔镜肝叶切除术中的应用  

Application of quadratus lumborum block at the lateral supra-arcuate ligament in laparoscopic hepatic lobectomy

作　　者：杨静 姬魁权 何锴 龙明波[1] 张永国[1] 陈绿绿 陈华侨 YANG Jing;JI Kuiquan;HE Kai;LONG Mingbo;ZHANG Yongguo;CHEN Lvlv;CHEN Huaqiao(Department of Anesthesiology,Guizhou QianNan People's Hospital,the First Afiliated Hospital of Qiannan Medical College For Nationalities,Guizhou Province,Duyun 558000,China)

机构地区：[1]贵州省黔南布依族苖族自治州人民医院黔南民族医学高等专科学校第一附属医院麻醉科,贵州都匀558000

出　　处：《中国当代医药》2025年第9期90-95,共6页China Modern Medicine

基　　金：黔南民族医学高等专科学校科研基金项目(Qnyz2024027)。

摘　　要：目的探讨弓状韧带上腰方肌阻滞在腹腔镜肝叶切除术中的应用。方法选取2023年3月至2024年9月黔南州人民医院择期行腹腔镜肝叶切除术的70例患者作为研究对象,采用随机数字表法分为直接全麻组(C组)和腰方肌阻滞联合全麻组(Q组),每组35例。C组直接全身麻醉(以下简称“全麻”)诱导气管插管,Q组行双侧弓状韧带上腰方肌阻滞后全麻诱导气管插管。两组患者均在控制性低中心静脉压下进行手术。记录两组患者术后第2、4、8、12、24小时咳嗽时视觉模拟评分法(VAS)评分,术中阿片药物总用量,术后24 h内自控镇痛(PCA)次数,术后首次下床走动时间,术后肛门首次排气时间,术后呼吸抑制、恶心及呕吐、尿潴留、瘙痒、胸闷等不良反应。结果Q组术后第2、4、8、12、24小时咳嗽时VAS评分低于C组,差异有统计学意义(P<0.05);两组患者术后第2、4、8、12、24小时咳嗽时VAS评分组内比较,差异无统计学意义(P>0.05)。Q组术中阿片药物总用量低于C组,术后24h内PCA次数少于C组,术后首次下床走动时间、术后肛门首次排气时间短于C组,差异有统计学意义(P<0.05)。Q组术后不良反应总发生率低于C组,差异有统计学意义(P<0.05)。结论弓状韧带上腰方肌阻滞应用于腹腔镜肝叶切除术中,能降低术后咳嗽时的疼痛评分,减少术中阿片药物总用量及术后24h内PCA次数,缩短术后首次下床走动时间和术后肛门首次排气时间,降低手术相关不良反应的发生率。Objective To investigate the application of quadratus lumborum block at the lateral supra-arcuate ligament in laparoscopic hepatic lobectomy.Methods A total of 70 patients who underwent elective laparoscopic hepatic lobectomy in Qiannan People's Hospital from March 2023 to September 2024 were selected as the research objects,and they were divided into direct general anesthesia group(group C)and quadratus lumborum block combined general anesthesia group(group Q)according to random number table method,with 35 cases in each group.Endotracheal intubation was induced by direct general anesthesia in group C,and endotracheal intubation was induced by general anesthesia in group Q after bilateral quadratus lumborum block at the lateral supra-arcuate ligament.Both groups underwent surgery under controlled low central venous pressure.Visual analogue scale(VAS)scores for cough at 2,4,8,12 and 24 hours after surgery,total intraoperative opioid consumption,number of patient controlled analgesia(PCA)within 24 hours after surgery,the time of first postoperative walking out of bed,first postoperative anal exhaust,postoperative respiratory depression,nausea and vomiting,urinary retention,pruritus,chest tightness and other adverse reactions were recorded in both groups.Results The VAS scores of the group Q at 2,4,8,12 and 24 hours after surgery were lower than those of the group C,the differences were statistically significant(P<0.05).There were no significant differences in VAS scores at 2,4,8,12 and 24 hours after surgery between the two groups(P>0.05).The total intraoperative opioid consumption in group Q was lower than that in group C,the number of PCA within 24 h after surgery was lower than that in group C,the time of first postoperative walking out of bed and first postoperative anal exhaust was shorter than that in group C,with statistical significances(P<0.05).The total incidence of postoperative adverse reactions in group Q was lower than that in group C,and the differ-ence was statistically significant(P<0.05).Conclusio

关 键 词：弓状韧带 腰方肌阻滞 腹腔镜 肝叶切除术 控制性低中心静脉压 

分 类 号：R614[医药卫生—麻醉学]