腰方肌阻滞联合羟考酮自控静脉镇痛对剖宫产术后镇痛的效果  

Analgesia Effect of Quadratus Lumbar Block Combined with Non-background Infusion Oxycodone in Patients Controlled Intravenous Analgesia after Cesarean Delivery

作　　者：李静[1] 任静 杨仕超 张建 程俊 罗玲 杨潘 徐向钊 邱正国 LI Jing;REN Jing;YANG Shichao;ZHANG Jian;CHENG Jun;LUO Ling;YANG Pan;XU Xiangzhao;QIU Zhengguo(Department of Anesthesiology,The Second Affiliated Hospital ofXi'an Medical University,Xi'an 710038,China;Department of Anesthesiology,Chang'an District Hospital,Xi'an 710100,China;Department of Anesthesiology,Nanchuan People's Hospital,Chongqing 408400,China;Department of Anesthesiology,The First Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine,Xianyang,712099,China)

机构地区：[1]西安医学院第二附属医院麻醉科,西安710038 [2]西安市长安区医院麻醉科,西安710100 [3]重庆市南川区人民医院麻醉科,重庆408400 [4]陕西中医药大学第一附属医院麻醉科,咸阳712099

出　　处：《宁夏医科大学学报》2025年第2期140-145,共6页Journal of Ningxia Medical University

基　　金：陕西省重点研发计划项目(2022SF-585)。

摘　　要：目的评价超声引导下腰方肌阻滞(QLB)联合无背景剂量羟考酮自控静脉镇痛(PCIA)用于剖宫产术后的镇痛效果。方法选择80例拟在腰-硬联合麻醉下行剖宫产术的产妇,随机分为QLB联合羟考酮组(BQ组)和QLB联合舒芬太尼组(BS组),每组40例。术毕两组均在超声引导下行双侧QLB,BQ组PCIA羟考酮不设背景剂量,自控剂量为2 mg;BS组PCIA舒芬太尼背景剂量为2μg·h^(-1),自控剂量为2μg。记录两组产妇术后48 h内不同时间点的静息痛视觉模拟评分(VAS),宫缩痛评分,Ramsay镇静评分,48 h PCIA给药总量,镇痛满意度评分。记录恶心、呕吐、头晕、嗜睡等不良反应。记录穿刺相关并发症如血肿、感染、局麻药中毒。结果与BS组比较,BQ组产妇术后静息痛VAS评分及术后2 h宫缩痛评分差异均无统计学意义(P均>0.05),BQ组术后4 h、8 h、12 h、24 h、48 h宫缩痛评分降低(P均<0.05)。两组产妇术后48 h内各时点镇静评分差异均无统计学意义(P均>0.05),BQ组术后48 h内镇痛药物消耗量(以吗啡等量计算)明显更少、术后镇痛满意度评分较高、恶心呕吐发生率较少(P均<0.05)。两组头晕、嗜睡等不良反应发生率差异无统计学意义(P>0.05)。两组均无穿刺相关并发症。结论超声引导下QLB联合无背景剂量羟考酮PCIA可更有效抑制剖宫产术后痛,减少术后产妇恶心、呕吐的发生率,提高患者的镇痛满意度。Objective To evaluate the efficacy of ultrasound-guided quadratus lumborum block(QLB)combined PCIA with non-background infusion of oxycodone hydrochloride for postoperative analgesia after cesarean delivery.Methods A total of 80 parturients who were scheduled for cesarean delivery under combined lumbar and epidural block.They were divided into two groups by random number table method QLB combined with oxycodone group(BQ group)and QLB combined with sufentanil group(BS group),with 40 cases in each group.After surgery,both groups underwent bilateral QLB under ultrasound guidance.The BQ group had no background dose of PCIA hydrocodone and a self controlled dose of 2 mg.The background dose of PCIA sufentanil in the BS group was 2μg·h^(-1),and the self controlled dose was 2μg.The visual analogue scale(VAS)scores,uterine contraction pain scores,Ramsay sedation scores were recorded at different time points within 48 hours after surgeries,as well as the total amount of PCIA administered in 48 h and analgesic satisfaction score were demermined.Nausea,vomiting,dizziness,somnolence and other adverse reactions and puncture related complications such as hematoma,infection,local anesthetic poisoning were recorded.Results Compared with the BS group,there was no statistical significance in the score of resting pain VAS and contraction pain 2 h after surgery in the BQ group(P>0.05),while the score of contraction pain at 4 h,8 h,12 h,24 h and 48 h after surgery was significantly decreased,with statistical significance(P<0.05).There were no statistically significant differences in sedation scores at various time points after surgery between the two groups(P>0.05).The consumption of analgesic drugs(calculated as equivalent amount of morphine)in BQ group within 48 h after surgery was significantly lower;the score of postoperative analgesia satisfaction was higher,and the incidence of nausea and vomiting was lower than BS group with statistical significance(P<0.05).There was no significant difference in the incidence of adverse reac

关 键 词：腰方肌阻滞 羟考酮 舒芬太尼 自控静脉镇痛 剖宫产 

分 类 号：R614[医药卫生—麻醉学]