筋膜下与筋膜外前路腰方肌阻滞效果的比较
Efficacy of subfacial versus extrafacial anterior quadratus lumborum block
吴进 1周晓峰 1秦奕帆 1佘慧钰 1陆沁源2
作者信息
- 1. 江苏大学附属医院麻醉科,镇江 212001
- 2. 江苏大学附属人民医院麻醉科,镇江 212002
- 折叠
摘要
目的 比较筋膜下和筋膜外前路腰方肌阻滞(AQLB)的效果.方法 试验Ⅰ本试验为回顾性研究.在江苏大学附属医院的影像归档与通信系统中,收集2023年1月至12月行腹部CT检查患者的图像,随机选择成年患者100例,无肌肉骨骼疾患以及胸腰椎手术史,观察L4水平腰方肌(QLM)和腰大肌(PMM)的解剖位置关系.试验Ⅱ本试验为前瞻性研究.选择江苏大学附属医院2024年1月至2月择期单侧AQLB下腹部手术男性患者20例,年龄18～65岁,体质量指数18～25 kg/m2,ASA分级Ⅰ或Ⅱ级,采用电脑产生的随机数字将患者分成筋膜下组和筋膜外组,每组10例(每组左侧和右侧各5例).采用0.375％罗哌卡因30 ml行AQLB:筋膜下组注射点位于L4水平QLM筋膜与胸腰筋膜前层(ATLF)之间,筋膜外组注射点位于L4水平PMM筋膜下.以体表标志线将阻滞侧躯体划分为15个区域,于阻滞后40 min时测定各区域皮肤感觉阻滞阳性情况及皮节感觉消失情况.于阻滞后40 min和术后1 h时采用改良Bromage评分评估下肢运动阻滞情况.结果 试验Ⅰ在L4水平,1例(1％)患者双侧QLM与PMM均接触,1例(1％)患者左侧QLM与PMM接触,其余98例(98％)患者QLM均与PMM分离.试验Ⅱ筋膜下组3、5、6、8区的阳性率以及T7-12皮节感觉消失率均高于筋膜外组(P＜0.05).筋膜外组阻滞后40 min时1例患者阻滞侧改良Bromage评分为1分,其余时点2组均为0分.结论 绝大部分患者L4水平QLM和PMM分离,筋膜下AQLB的中下腹阻滞效果优于筋膜外AQLB,且无运动阻滞.
Abstract
Objective To compare the efficacy of subfascial and extrafascial anterior quadratus lumborum block(AQLB).Methods This study included two trials.Trial Ⅰ This trail was a retrospective study.The images of patients undergoing abdominal CT examination from January to December 2023 were retrospectively analyzed in the picture archiving and communication system of the Affiliated Hospital of Jiangsu University.One hundred adult patients with no musculoskeletal disorders or history of thoracolumbar surgery were randomly selected,and the anatomical relation between the quadratus lumbar muscle(QLM)and psoas major muscle(PMM)at the L4 level was observed.Trial Ⅱ This trail was a prospective study.Twenty American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ male patients,aged 18-65 yr,with a body mass index of 18-25 kg/m2,who underwent elective unilateral AQLB lower abdominal surgery in Affiliated Hospital of Jiangsu University from January to February 2024,were included and divid-ed into subfascial group and extrafascial group using computer-generated random numbers,with 10 cases per group(5 cases on the left and 5 cases on the right side each).AQLB was performed using 0.375％ropiva-caine 30 ml:the injection point for subfascial group was located between the fascia of the QLM and the ante-rior layer of the thoracolumbar fascia at the L4 level,while the injection point for extrafascial group was loca-ted underneath the fascia of the PMM at the L4 level.The blocked side of the body was divided into 15 re-gions using the anatomical landmarks on the body surface.The positive rates of skin sensory block and sen-sory disappearance of dermatomes in each region were assessed by cold stimulation at 40 min after block.The modified Bromage score was used to evaluate the lower limb motor block at 40 min after block and 1 h after surgery.Results Part Ⅰ At the L4 level,the overlapping of the bilateral QLM and PMM only oc-curred in 1 patient(1％),the overlapping only appearing on the left side occurred in 1 patient(1％),and the PMM and QLM in the remaining 98 patients(98％)were separated.Part Ⅱ The positive rates in 3,5,6 and 8 regions and the sensory disappearance rates of T7 to T12 dermatomes were significantly higher in subfas-cial group than in extrafascial group(P＜0.05).One patient in extrafascial group had a modified Bromage score of 1 on the block side at 40 min after block,and both groups scored 0 at the other time points.Conclu-sions QLM and PMM are separated at the L4 level in most patients.Subfascial AQLB is more effective than extrafascial AQLB in blocking the middle-lower region of the abdominal wall and has no motor block.
关键词
腰肌/神经传导阻滞/筋膜Key words
Psoas muscles/Nerve block/Fascia引用本文复制引用
基金项目
江苏省研究生科研与实践创新计划项目(SJCX23_2100)
镇江市"金山英才"高层次领军人才培养计划科研项目(YLJ202109)
江苏大学医教协同创新基金项目(JDY2022006)
江苏大学附属医院新技术新项目(xjs2024124)
出版年
2024
NETL
NSTL
万方数据