摘要
目的 探讨超声引导下双侧弓状韧带上腰方肌阻滞(QLB-LSAL)在子宫内膜癌患者全子宫切除术中的麻醉效果。方法 前瞻性纳入98例拟行腹腔镜全子宫切除术治疗的子宫内膜癌患者为研究对象,根据随机信封法随机分为观察组和对照组,各49例。对照组患者在超声引导下行腹横肌平面阻滞麻醉(TAPB),观察组患者在超声引导下行双侧QLB-LSAL。比较两组术后6 h、24 h疼痛程度[视觉模拟评分法(VAS)]及镇静程度(Ramsay评分),记录患者入室时(T_(0))、气管插管(T_(1))、手术结束时(T_(2))的心率和平均动脉压;术后恢复情况及麻醉不良反应发生情况。结果 观察组术后6 h VAS评分及Ramsay评分低于对照组(P<0.05)。观察组术后48 h自控镇痛按压次数、舒芬太尼用量少于对照组,术后苏醒时间、首次下床活动时间短于对照组(P<0.05);两组T_(0)时心率、平均动脉压比较无差异(P>0.05);两组T_(1)、T_(2)时心率、平均动脉压均较T_(0)时升高,但观察组T_(1)、T_(2)时心率、平均动脉压均低于对照组(P<0.05);观察组术后不良反应发生率低于对照组(P<0.05)。结论 超声引导下双侧QLB-LSAL在子宫内膜癌患者全子宫切除术中应用,能发挥理想的镇痛、镇静效果,保持患者血流动力学稳定,可减少麻醉药物用量及麻醉不良反应。
Objective To explore the anesthesia effect of ultrasound-guided quadratus lumborum block at the lateral supra-arcuate ligament(QLB-LSAL)in total hysterectomy for endometrial cancer patients.Methods A prospective study was conducted on 98 patients with endometrial cancer who planned to undergo laparoscopic total hysterectomy.They were randomly divided into the observation group and the control group using the random envelope method,with 49 patients in each group.The control group underwent transabdominal transverse muscle plane block anesthesia(TAPB)under ultrasound guidance,while the observation group underwent bilateral QLB-LSAL under ultrasound guidance.The pain level(VAS)and sedation level(Ramsay score)were compared between the 2 groups at 6 and 24 hours after surgery,and the heart rate and mean arterial pressure of patients at entry(T 0),tracheal intubation(T 1),and end of surgery(T 2),postoperative recovery and occurrence of adverse anesthesia reactions were recorded.Results The VAS score and Ramsay score of the observation group at 6 hours after surgery were lower than those of the control group(P<0.05).The observation group had fewer self-control analgesia compressions and sufentanil dosage 48 hours after surgery compared to the control group,and had shorter postoperative recovery time and first time out of bed activity time(P<0.05).There was no significant difference in heart rate and mean arterial pressure between the two groups at T 0(P>0.05).The heart rate and mean arterial pressure of both groups increased at T 1 and T 2 compared to T 0,but the heart rate and mean arterial pressure of the observation group were lower than those of the control group at T 1 and T 2(P<0.05).The incidence of postoperative adverse reactions was lower in the observation group than in the control group(P<0.05).Conclusion The application of bilateral QLB-LSAL under ultrasound guidance in total hysterectomy for endometrial cancer patients can achieve ideal analgesic and sedative effects,maintain patient hemodynamic stability,and reduce the dosage of anesthetic drugs and adverse anesthesia reactions.
作者
周洁
杨卫华
ZHOU Jie;YANG Weihua(Puyang People's Hospital,Puyang,457000)
出处
《实用癌症杂志》
2025年第3期421-424,共4页
The Practical Journal of Cancer
关键词
子宫内膜癌
腹腔镜全子宫切除术
超声引导
双侧弓状韧带上腰方肌阻滞
腹横肌平面阻滞
Endometrial cancer
Laparoscopic total hysterectomy
Ultrasound-guidance
Quadratus lumborum block at the lateral supra-arcuate ligament
Transabdominal transverse muscle plane block anesthesia
