超声引导下弓状韧带上腰方肌前侧阻滞对腹腔镜手术患者术后恢复质量的影响  

Effect of ultrasound-guided anterior quadratus lumborum block at supra-arcuate ligament on quality of postoperative recovery in patients undergoing laparoscopic surgery

作　　者：过雪艳 王迪 洪红[1] 纪木火 童建华 Guo Xueyan;Wang Di;Hong Hong;Ji Muhuog;Tong Jianhua(Department of Anesthesiology,the Second Afiliated Hospital of Nanjing Medical University,Nanjing 210011,China)

机构地区：[1]南京医科大学第二附属医院麻醉科,南京210011

出　　处：《中华麻醉学杂志》2025年第3期325-328,共4页Chinese Journal of Anesthesiology

摘　　要：目的:评价超声引导下弓状韧带上腰方肌前侧阻滞(SA-AQLB)对腹腔镜手术患者术后恢复质量的影响。方法:本研究为随机对照研究。择期腹腔镜手术患者110例,性别不限,年龄18~80岁,BMI 18~28 kg/m 2,ASA分级Ⅰ-Ⅲ级。采用随机数字表法将其分为2组(n=55):腹横肌平面阻滞(TAPB)组(T组)和SA-AQLB组(S组)。术毕送至麻醉后恢复室并连接患者自控静脉镇痛(PCIA)泵,于拔除气管导管后5 min行神经阻滞,T组和S组分别行超声引导下双侧TAPB和SA-AQLB,每侧分别注射0.25%罗哌卡因30 ml。数字评定量表评分≥4分时静脉注射羟考酮3~5 mg或地佐辛5 mg,记录补救镇痛情况;记录PCIA首次按压时间和有效按压次数;记录术后24 h舒芬太尼等效消耗量;于术后24和48 h时记录15项恢复质量量表评分;记录术后首次下床活动时间和住院时间;记录术后头晕、恶心呕吐、呼吸抑制和神经阻滞并发症的发生情况。结果:与T组比较,S组术后舒芬太尼等效消耗量降低,PCIA有效按压次数减少,补救镇痛率降低,PCIA首次按压时间延长,术后24和48 h时15项恢复质量量表评分升高,首次下床活动时间和住院时间缩短(P<0.05)。结论:超声引导下SA-AQLB改善腹腔镜手术患者术后恢复质量的效果优于TAPB。Objective:To evaluate the effect of ultrasound-guided anterior quadratus lumborum block at the supra-arcuate ligament(SA-AQLB)on the quality of postoperative recovery in patients undergoing laparoscopic surgery.Methods:In this randomized controlled study,110 American Society of Anesthesiologists Physical Status classificationⅠ-Ⅲpatients,aged 18-80 yr,with a body mass index of 18-28 kg/m 2,scheduled for elective laparoscopic surgery,were assigned to 2 groups(n=55 each)using a random number table method:transversus abdominis plane block(TAPB)group(group T)and SA-AQLB group(group S).The patients were sent to postanesthesia care unit and connected to patient-controlled intravenous analgesia(PCIA)pump after surgery.T group received ultrasound-guided bilateral TAPB and S group received ultrasound-guided bilateral SA-AQLB at 5 min after removal of the endotracheal tube under ultrasound guidance,with 30 ml of 0.25%ropivacaine injected on each side.Oxycodone 3-5 mg or diazoxide 5 mg was intravenously injected when the numerical rating scale score≥4,and the requirement for rescue analgesia was recorded.The time to the first pressing and effective pressing times of PCIA were recorded,and the equivalent consumption of sufentanil at 24 h after operation was also recorded.The Quality of Recovery-15 scores were recorded at 24 and 48 h after surgery.The time to first ambulation and postoperative length of hospital stay were recorded.The occurrence of postoperative dizziness,nausea and vomiting,respiratory depression and nerve block complications was recorded.Results:Compared with group T,the equivalent consumption of sufentanil at 24 h postoperatively was significantly decreased,the effective pressing times of PCIA were reduced,the rate of rescue analgesia was decreased,the time to the first pressing of PCIA was prolonged,Quality of Recovery-15 scores were increased at 24 and 48 h after surgery,and the time to first ambulation and postoperative length of hospital stay were shortened in group S(P<0.05).Conclusions:Ultrasoun

关 键 词：超声检查 腰肌 神经传导阻滞 弓状韧带 腹腔镜检查 恢复质量 

分 类 号：R614[医药卫生—麻醉学]