弓状韧带上腰方肌前路阻滞在腹腔镜下肾及肾周手术中的应用
Application of quadratus lumborum block at the lateralsupra-arcuate ligament in laparoscopic renal and perirenal surgery
简骏 1利莉2
作者信息
- 1. 南宁市第二人民医院麻醉科,广西南宁市 530031
- 2. 广西医科大学第一附属医院麻醉科,广西南宁市 530000
- 折叠
摘要
目的 探讨弓状韧带上腰方肌前路阻滞(QLB-LSAL)在腹腔镜下肾及肾周手术中的应用效果.方法 选取择期行腹腔镜下肾或肾周手术的45例患者为研究对象,将其随机分为Q组(n=22)和T组(n=23).在常规全身麻醉下,Q组患者行超声引导下外侧QLB-LSAL,T组患者行超声引导下腹横肌平面阻滞(TAPB)(均采用0.375％罗哌卡因20mL单侧单次注射).比较两组患者进入手术室时(T0)、手术开始时(T1)、手术结束时(T2)、苏醒时(T3)和离开复苏室时(T4)的平均动脉压(MAP)和心率,比较术后苏醒时及术后12 h、24 h、48 h的静态和动态疼痛数字量表(NRS)评分,比较术中和术后48 h内镇痛药物使用量,比较术后快速康复指标(包括苏醒时间、术后肠道排气时间、术后下床活动时间、术后出院时间)和术后并发症发生情况(头晕头痛、恶心呕吐、神经阻滞并发症的发生率).结果 两组患者各时间点MAP、心率比较,差异均无统计学意义(均P＞0.05);术后苏醒时及术后12h、48h,两组患者的动静态NRS评分差异均无统计学意义(均P＞0.05);术后24 h,两组患者的动态NRS评分差异无统计学意义(P＞0.05),但Q组患者的静态NRS评分明显高于T组(P＜0.05).两组患者术中、术后48 h内镇痛药物使用总量、术后快速康复指标及并发症发生率比较,差异均无统计学意义(均P＞0.05).结论 QLB-LSAL的镇痛作用与TAPB相当,可以为腹腔镜下肾及肾周手术提供安全有效的辅助镇痛,值得临床进一步应用推广.
Abstract
Objective To explore the application effect of quadratus lumborum block at the lateralsupra-arcuate ligament(QLB-LSAL)in laparoscopic renal and perirenal surgery.Methods Forty-five patients who underwent laparoscopic renal or perirenal surgery were selected as study subjects and randomly divided into group Q(n=22)and group T(n=23).Under conventional general anesthesia,patients in group Q were treated with ultrasound-guided lateral QLB-LSAL,while patients in group T were treated with ultrasound-guided transversus abdo-minal plane block(TAPB)(both groups were given unilateral single injection of 0.375％ropivacaine 20 mL).The mean arterial pressure(MAP)and heart rate were compared between the two groups at the time of entering the operating room(T0),at the beginning of surgery(T1),at the end of surgery(T2),at the time of awakening(T3),and at the time of leaving the recovery room(T4).The Numerical Rating Scale(NRS)scores of static and dynamic pain were compared at the time of postoperative awakening and at 12 hours,24 hours and 48 hours after surgery.The dosage of analgesic medication used during surgery and within 48 hours after surgery were compared.The postoperative rapid recovery indicators(including the time of awakening,postoperative intestinal exhaust,postoperative ambulation and postoperative discharge),and the occurrence of postoperative complications(incidence of dizziness,headache,nausea and vomiting,nerve block complications)were compared.Results There was no statistically significant difference in MAP and heart rate between the two groups at each time point(all P＞0.05).There was no statistically significant difference in the dynamic and static NRS scores between the two groups of patients at postoperative awakening,12 hours,and 48 hours after surgery.Twenty-four hours after surgery,there was no statistically significant difference in the dynamic NRS scores between the two groups of patients(P＞0.05),but the static NRS scores of patients in the group Q were significantly higher than that in the group T(P＜0.05).There was no statistically significant difference in the total dosage of analgesic medication used during and 48 hours after surgery,as well as the postoperative rapid recovery indicators and incidence of complications between the two groups of patients(all P＞0.05).Conclusion The analgesic effect of QLB-LSAL is comparable to that of TAPB,and it can also provide a safe and effective auxiliary analgesic effect for laparoscopic renal and perirenal surgery,which is worthy of further clinical application and promotion.
关键词
麻醉药/神经肌肉阻滞/腰方肌阻滞/肾周手术/腹腔镜Key words
Anesthetic/Neuromuscular blockade/Quadratus lumborum block/Perirenal surgery/Laparoscope引用本文复制引用
出版年
2024
国家科技期刊平台
NSTL
万方数据