超声引导下腰方肌阻滞对腹腔镜肾囊肿去顶术后镇痛效果的影响

doi:10.3969/j.issn.1005-6483.2019.06.009

摘要/Abstract

摘要： 目的探讨超声引导下腰方肌阻滞（quadratus lumborum block，QLB）对腹腔镜肾囊肿去顶术后镇痛效果的影响。方法选择在我院行全麻腹腔镜肾囊肿去顶术病人60例，ASA分级Ⅰ～Ⅱ级。采用随机数字表法随机分为两组：全麻联合QLB组（QLB 组）和单纯全麻组（C组），每组30例。QLB 组病人于全麻诱导后手术开始前行超声引导下术侧QLB，给予0.4%罗哌卡因25ml；C组单纯全麻。观察记录术中舒芬太尼用量、术后不同时间点视觉模拟评分（visual analogue scores，VAS）、术后镇痛泵首次按压时间、术后舒芬太尼总用量、补救性镇痛次数、恶心呕吐发生情况和病人镇痛满意度。结果 C组术中舒芬太尼用量为（32.8±3.6）μg、术后2、4、6、8、12、24h VAS评分分别为2.1±0.9，2.8±0.9，3.6±0.8，3.0±1.2，3.0±1.5，2.9±1.2；镇痛泵首次按压时间（56.6±14.9）min，术后镇痛舒芬太尼总用量（61.9±22.9）μg，补救性镇痛发生次数12例，恶心呕吐发生例数10例，病人术后镇痛满意度（6.9±1.4）分，QLB组分别为（27.3±5.2）μg，1.4±0.7，1.6±0.6，1.6±0.6，2.0±0.7，2.1±1.0，2.1±1.1，（684.3±162.7）min，（16.2±6.6）μg，5例，3例，7.7±1.3，两组比较差异均有统计学意义P<0.05）。结论 QLB可减少腹腔镜肾囊肿去顶术中及术后阿片类药物用量，改善术后镇痛效果，提高病人满意度。

关键词: 超声引导, 腰方肌阻滞, 肾囊肿去顶术, 镇痛

Abstract: Objective To evaluate the analgesia effects of ultrasound-guided quadratus lumborum block in patients undergoing laparoscopic renal cyst unroofing.Methods Sixty ASA Ⅰ or Ⅱ patients，scheduled for elective laparoscopic unroofing of renal cyst，were randomly divided into two groups（n=30）：ultrasound-guided QLB combined with general anesthesia group（group QLB）and simple general anesthesia group（group C）.In group QLB，QLB was performed with 25ml of 0.4% ropivacaine injection in operation side after induction of general anesthesia ，while group C received simple general anesthesia.Intraoperative sufentanil dosage，visual analogue scores（VAS）at different postoperative time points，first compression time of postoperative analgesia pump，total postoperative sufentanil dosage，number of postoperative analgesia，incidence of nausea and vomiting，and patient satisfaction with analgesia were observed and recorded.Results The consumption of intraoperative and postoperative sufentanil in group QLB were （27.3±5.2）μg and （16.2±6.6）μg;the VAS of 2，4，6，8，12，24h of post-operation were 1.4±0.7，1.6±0.6，1.6±0.6，2.0±0.7，2.1±1.0，2.1±1.1，respectively;first compression time of analgesic pump was （684.3±162.7）min;the times of remedial analgesia and nausea or vomiting was 5 and 3;patient satisfaction with postoperative analgesia was 7.7±1.3.While in group C was（32.8±3.6）μg，（61.9±22.9）μg，2.1±0.9，2.8±0.9，3.6±0.8，3.0±1.2，3.0±1.5，2.9±1.2，（56.6±14.9）min，12 cases，10 cases，6.9±1.4，respectively.The difference between the two groups was statistically significant（P<0.05）.Conclusion Ultrasound-guided QLB with 0.4% ropivacaine can reduce the opioid consumption and enhance the efficacy of postoperative analgesia for patients under going laparoscopic renal cyst unroofing.It can improve the patient's comfort and satisfaction.

Key words: ultrasonography, quadratus lumborum block, renal cyst unroofing, analgesia

关江, 夏中元, 郭尔萍. 超声引导下腰方肌阻滞对腹腔镜肾囊肿去顶术后镇痛效果的影响[J]. 临床外科杂志, 2019, 27(6): 474-476.

GUAN Jiang, XIA Zhongyuan, GUO Erping.. Evaluation on analgesic effect of ultrasound guided quadrates lumborum block in patients undergoing laparoscopic renal cyst unroofing[J]. JOURNAL OF CLINICAL SURGERY, 2019, 27(6): 474-476.

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