超声引导下不同入路腰方肌阻滞在股骨头坏死患者术后镇痛中的效果研究
Comparative research on effects of different approaches of quadratus lumbar block under the guidance of ultrasound on postoperative analgesia of patients with femoral head necrosis
张立 1张颖 1王立平1
作者信息
- 1. 唐山市第二医院麻醉科 唐山 063000
- 折叠
摘要
目的:比较超声引导下3种不同入路腰方肌阻滞(QLB)在股骨头坏死患者术后镇痛中的效果.方法:选取2019年5月至2021年5月唐山市第二医院收治的120例股骨头坏死患者,采用动态随机化分组法将其按3种不同入路QLB镇痛方法分为腰方肌外侧组、腰方肌后路组和腰方肌前路组,每组40例.所有患者均行髋关节置管术治疗,于术后行腰方肌外侧路、后路和前路QLB镇痛方法.比较3组镇痛前,镇痛后1、6和12 h视觉模拟量表(VAS)评分,及用药后不良反应发生率.结果:采用广义估计方程分析,3组VAS评分在镇痛后1 h时[3.83(3.51,4.01)分、3.15(2.99,3.43)分、3.25(3.08,3.53)分]至镇痛后12 h时[3.18(3.03,3.50)分、2.80(2.65,2.95)分、2.80(2.55,2.97)分]处于降低趋势,组内不同时点VAS评分比较,差异有统计学意义(Wald x2=2 778.131,P＜0.05);后路组、前路组镇痛后不同时点VAS评分均低于侧路组(Wald x2=102.935,P＜0.05);后路组、前路组镇痛后VAS评分的降低趋势大于侧路组,即腰方肌前路、腰方肌后路的镇痛效果强于腰方肌外侧路(Wald x2=25.245,P＜0.05).结论:超声引导下采用腰方肌前路、腰方肌后路行QLB用于股骨头坏死患者术后镇痛效果显著高于腰方肌外侧路,3种不同入路下行QLB镇痛的不良反应差异不显著.
Abstract
Objective:To compare the application effect of three different approaches of quadratus lumbar block(QLB)under the guidance of ultrasound in postoperative analgesia of patients with femoral head necrosis.Methods:A total of 120 patients with femoral head necrosis who admitted to the Second Hospital of Tangshan from May 2019 to May 2021 were selected.According to dynamic randomization grouping method,they were divided into lateral lumbar quadratus group,posterior lumbar quadratus group and anterior lumbar quadratus group as three different approaches of QLB analgesia,with 40 cases in each group.All patients were treated with hip catheterization,and the lateral,posterior and anterior QLB analgesia methods were performed after surgery.The visual analogue scale(VAS)scores of the three groups were compared before analgesia and at the 1st,6th and 12th h after analgesia,and the incidences of adverse reactions among the three groups after medication were compared.Results:The analysis of generalized estimation equation showed that the VAS scores of the three groups appeared a decreasing trend from 1h after analgesia to 12h after analgesia,and they were respectively 3.83(3.51,4.01)points,3.15(2.99,3.43)points,3.25(3.08,3.53)points vs.3.18(3.03,3.50)points,2.80(2.65,2.95)points,2.80(2.55,2.97)points.There was statistical significant difference in VAS scores among different time points within the group(Wald x2=2 778.131,P<0.05).The VAS scores at different time points after analgesia in posterior approaches group and anterior approaches group were lower than those in lateral approaches group(Wald x2=102.935,P<0.05).The decrease trend of VAS scores after analgesia in posterior approaches group and anterior approaches was larger than that in lateral approaches group,which meant that the analgesic effect of anterior approaches and posterior approaches of lumbar quadratus was stronger than that of lateral approach of lumbar quadratus(Wald x2=25.245,P<0.05).Conclusion:The postoperative analgesic effect of ultrasound-guided QLB by adopting anterior and posterior approaches of lumbar quadratus muscle is significantly higher than that by adopting lateral approach of lumbar quadratus muscle in patients with femoral head necrosis.There is no significant difference in adverse reactions of undergoing QLB analgesia under three different approaches.
关键词
股骨头坏死/髋关节置换术/疼痛程度/腰方肌阻滞(QLB)Key words
Femoral head necrosis/Hip catheterization/Degree of pain/Quadratus lumbar block(QLB)引用本文复制引用
基金项目
河北省医学科学研究课题(2020)(20201450)
出版年
2024
国家科技期刊平台
NSTL
万方数据