目的 探讨弓状韧带上腰方肌阻滞复合全身麻醉在肾癌患者手术中的应用效果.方法 前瞻性纳入118例肾癌患者作为研究对象,采用随机数字表法分为2组,各59例.2组患者均行腹腔镜下根治性肾切除术治疗,对照组实施全身麻醉,观察组实施弓状韧带上腰方肌阻滞复合全身麻醉.比较2组术中血流动力学(心率、平均动脉压)、苏醒后疼痛程度[采用疼痛强度数字分级法(NRS)评估]变化情况,比较2组患者术中丙泊酚、瑞芬太尼使用量及术后24 h内镇痛泵按压次数,记录2组术后不良反应发生情况.结果 2组T0时心率及平均动脉压对比,差异无统计学意义(P＞0.05);2组T1、T2、T3时的心率及平均动脉压均低于T0时,且观察组低于对照组,差异有统计学意义(P＜0.05);观察组T1、T2、T3时心率及平均动脉压变化不明显,差异无统计学意义(P＞0.05);但对照组T1、T2、T3时心率及平均动脉压波动较大,差异有统计学意义(P＜0.05).2组苏醒后2、6、12 h NRS评分均呈上升趋势,至苏醒后24 h均呈下降趋势,但与对照组相比,观察组各时点NRS评分均较低,差异有统计学意义(P＜0.05).与对照组相比,观察组术中丙泊酚及瑞芬太尼使用量较少,术后镇痛泵首次按压时间较长,术后24 h内镇痛泵按压次数较少,差异有统计学意义(P＜0.05).观察组不良反应发生率低于对照组,差异有统计学意义(P＜0.05).结论 与单纯全身麻醉相比,肾癌手术患者术中使用弓状韧带上腰方肌阻滞复合全身麻醉可达到更好的麻醉效果,有利于维持血流动力学稳定性,减轻术后疼痛,延长术后镇痛时间,减少镇痛药物使用量,并降低术后不良反应发生率.
Application of Quadratus Lumborum Superior Arcuate Ligament Block Combined with General Anesthesia in Patients Undergoing Renal Carcinoma Surgery
Objective To investigate the effect of quadratus lumborum superior arcuate ligament block combined with general anesthesia in renal carcinoma surgery.Methods A prospective study was conducted on 118 patients with renal carcinoma as the research object.They were divided into 2 groups with 59 patients each by random number table.Both groups were treated with laparoscopic radical nephrectomy.The control group was given general anesthesia,and the observation group was given quad-ratus lumborum superior arcuate ligament block combined with general anesthesia.The changes of hemodynamics(heart rate,mean arterial pressure)and post awakening pain[evaluated by numerical rating of pain intensity(NRS)]were compared between the 2 groups during operation,the amount of propofol and remifentanil used in the 2 groups was compared during operation,and the number of times the analgesia pump was pressed within 24 hours after operation,and the adverse reactions of the 2 groups after operation was recorded.Results There was no statistical significant difference in heart rate and mean arterial pressure between the 2 groups at T0(P＞0.05).Compared with T0,the heart rate and mean arterial pressure at T1,T2 and T3 in both groups were lower,and compared with the control group,those in the observation group were lower,with a statistical significant difference(P＜0.05).There was no statistical significant difference in heart rate and mean arterial pressure at T1,T2 and T3 in the observation group(P＞0.05).However,the heart rate and mean arterial pressure in T1,T2 and T3 of the control group fluctuated significantly,the difference was statistically significant(P＜0.05).The NRS scores of the 2 groups showed an upward trend at 2,6 and 12 hours after awakening and a downward trend at 24 hours after awakening,but compared with the control group,the NRS scores of the observation group were lower at each time point,with a statistical significant difference(P＜0.05).Compared with the control group,the amount of propofol and remifentanil used during operation in the observation group was less,the first press time of the postoperative analgesia pump was longer,and the number of press times of the analgesia pump within 24 hours after operation was less,the difference was statistically significant(P＜0.05).The incidence of adverse reactions in the observation group was lower than that in the control group,the difference was statistically significant(P＜0.05).Conclusion Compared with simple general anesthesia,quadratus lumborum superior arcuate ligament block combined with general anesthesia can achieve better anesthesia effect in patients undergoing renal carcinoma surgery,which is conducive to maintaining hemodynamic stability,reducing postoper-ative pain,prolonging postoperative analgesia time,reducing the use of analgesic drugs,and reducing the incidence of postoperative adverse reactions.
Renal carcinomaQuadratus lumborum superior arcuate ligament blockGeneral anesthesia
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