目的:探讨超声引导下弓状韧带上腰方肌阻滞(SA-QLB)对二次剖宫产术后镇痛效果及术后恢复质量的影响.方法:选取2022年12月-2024年3月于本院行二次剖宫产产妇60例,随机分为观察组和对照组各30例.术毕超声引导下观察组行SA-QLB,对照组行后路腰方肌阻滞(P-QLB).比较两组不同时点切口痛和宫缩痛视觉模拟量表(VAS)评分及阻滞节段、术后镇痛情况、术后恢复指标、阻滞操作时间、不良反应及阻滞相关并发症.结果:观察组阻滞后 6、12、24 h 宫缩痛 VAS评分 M(P25,P75)为 2.0(1.0,2.0)、3.0(2.0,3.0)、2.0(2.0,3.0)分,低于对照组 3.0(2.0,3.0)、3.0(3.0,5.0)、3.0(3.0,4.0)分,阻滞后 6、12、24、48 h 阻滞节段[8.0(8.0,9.0)个、8.0(7.0,8.0)个、7.0(6.0,7.0)个、2.0(2.0,3.0)个]多于对照组[5.0(5.0,6.0)个、3.0(3.0,4.0)个、2.0(1.0,2.0)个、0 个],术后 48 h 舒芬太尼消耗量[48.0(48.0,48.0)μg]少于对照组[48.0(48.0,52.0)μg],宫缩痛中重度疼痛发生率(6.7％)低于对照组(30.0％),术后24 h ObsQoR-11评分[(96.7±7.0)分]高于对照组[(92.6±7.3)分],阻滞操作时间[8.0(7.0,9.0)min]长于对照组[5.0(4.0,6.0)min](均P＜0.05).两组不同时点切口痛VAS评分、切口痛中重度疼痛发生率、镇痛补救率、镇痛满意度、首次排气时间、首次下床时间、恶心呕吐发生率无统计学差异(均P＞0.05),均未发生其他不良反应及阻滞相关并发症.结论:与P-QLB相比,SA-QLB阻滞平面更广,可更有效缓解二次剖宫产产妇术后宫缩痛,改善术后早期恢复质量,但阻滞操作时间长,阻滞体位摆放困难,其在二次剖宫产中的应用优势仍需进一步研究验证.
Effects of the ultrasound-guided supra-arcuate ligament quadratus lumborum block for women with the second caesarean section on their postoperative analgesia and recovery quality
Objective:To explore the effects of the ultrasound-guided supra-arcuate ligament quadratus lumborum block(SA-QLB)for women with the second caesarean section on their postoperative analgesia and recovery quality.Meth-ods:60 pregnant women who wanted the second cesarean section were selected and were randomly divided into obser-vation group(n=30)and control group(n=30)from December 2022 to March 2024.The women in the observation group were given SA-QLB during cesarean section,and the women in the control group were given the posterior quad-ratus lumborum block(P-QLB).The visual analogue scale(VAS)scores of the incision pain and the uterine contrac-tion pain at different time points,the block segment,the postoperative analgesic effect,the postoperative recovery in-dicators values,the block operation time,and the rates of adverse reactions and block-related complications of the women were compared between the two groups.Results:The VAS score[M(P25,P75)]of the uterine contraction pain of the women in the observation group at 6h,12h,and 24 after the anesthesia block were 2.0(1.0,2.0)points,3.0(2.0,3.0)points and 2.0(2.0,3.0)points,respectively,and which were significantly lower than those[3.0(2.0,3.0)points,3.0(3.0,5.0)points and 3.0(3.0,4.0)points,respectively]of the women in the control group.The number of the block segments of the women in the observation group at 6 h,12h,24h,and 48h after anesthesia block were 8.0(8.0,9.0),8.0(7.0,8.0),7.0(6.0,7.0)and 2.0(2.0,3.0),respectively,and which were significantly more than those[5.0(5.0,6.0),3.0(3.0,4.0),2.0(1.0,2.0)and 0,respectively]of the women in the control group.The consumption dosage of sufentanil[48.0(48.0,48.0)ug]of the women in the observation control group in 48h after op-eration was significantly less than that[48.0(48.0,52.0)ug]of the women in the control group.The incidence of the moderate and severe uterine contraction pain(6.7％)of the women in the observation group was significantly lower than that(30.0％)of the women in the control group.The ObsQoR-11 score(96.7±7.0 points)of the women in the observation group at 24h after operation was significantly higher than that(92.6±7.3 points)of the women in the con-trol group,and the block operation time(8.07,0-9.0 min)of the women in the observation group was significantly longer than that(5.0,4.0-6.0 min)of the women in the control group(all P＜0.05).There were no significant differ-ences in the VAS score of the incision pain at different time points,the incidence of the moderate or severe pain of the incision,the rate of the postoperative analgesia again,the analgesic satisfaction,the first exhaust time,the first time of getting out of the bed,the incidence of nausea and vomiting of the women between the two groups(all P＞0.05).There were no other adverse reactions and block-related complications of the women in the two groups.Conclusion:Compared with those of P-QLB,the block plane of SA-QLB for the women with the second caesarean section is much wider,and which can effectively alleviate the postoperative uterine contraction pain and improve the early recovery quality of these women.However,the block operation time of SA-QLB is longer and the placement of the block posi-tion is more difficult,and so its advantages of the women with the second caesarean section still need further research and verification.
Supra-arcuate ligament quadratus lumborum blockThe second caesarean sectionAnalgesiaPostopera-tive recovery
万方数据
维普
