摘要
目的比较超声引导下四种不同腰方肌阻滞入路(QLB)对腹腔镜全子宫切除术患者围术期镇痛效果的影响。方法200例行腹腔镜全子宫切除术的患者,按照随机数字表法将患者分为五组:Q1组、Q2组、Q3组、Q4组和C组,每组40例。术中穿刺靶点:Q1组(后路):腰方肌后表面与腹横肌筋膜之间;Q2组(外侧路):腰方肌后表面、竖脊肌外侧的“腰筋膜三角”区域;Q3组(前路):腰方肌与腰大肌之间的间隙;Q4组(肌内入路):腰方肌肌肉组织内;C组(对照组):不予任何神经阻滞。对比五组术中阿片类药物用量、术后镇痛视觉模拟评分法(VAS)评分、术后不良事件发生情况。结果五组术中舒芬太尼、瑞芬太尼用量对比有统计学差异(P<0.05);Q1、Q2、Q3、Q4组术中舒芬太尼用量[(5.63±4.96)、(3.13±3.70)、(1.25±2.47)、(6.25±5.40)μg]和瑞芬太尼用量[(1.41±0.29)、(1.22±0.25)、(0.83±0.20)、(1.62±0.28)mg]明显少于C组[(9.38±5.79)μg、(2.05±0.37)mg],且Q3组术中舒芬太尼用量和瑞芬太尼用量明显少于Q1、Q2、Q4组,对比有统计学差异(P<0.05);而五组术中丙泊酚用量对比无明显差异(P>0.05)。Q1、Q2、Q3、Q4组术后即刻、术后6 h、术后12 h、术后24 h的静息及动态VAS评分均明显低于C组,且Q3组低于Q1、Q2、Q4组,对比有统计学差异(P<0.05)。五组术后不良事件(恶心/呕吐、尿潴留、肌力减退、感觉减退)发生率均较低,对比无明显差异(P>0.05)。结论四种入路的腰方肌阻滞均能为腹腔镜全子宫切除术提供有效的镇痛并减少阿片类药物用量,尤以前路入路的效果最为显著。
Objective To compare the impact of four ultrasound-guided quadratus lumborum block(QLB)approaches on analgesic effects of patients undergoing laparoscopic total hysterectomy.Methods According to random numerical table,200 patients undergoing laparoscopic total hysterectomy were allocated to five groups:Group Q1,Group Q2,Group Q3,Group Q4,and Group C,with 40 patients in each group.Intraoperative puncture targets:Group Q1(posterior approach):between the posterior surface of the quadratus lumborum and the fascia of the transversus abdominis;Group Q2(lateral approach):the"lumbar fascia triangle"region on the posterior surface of the quadratus lumborum and lateral to the erector spinae;Group Q3(anterior approach):the space between the quadratus lumborum and the psoas major;Group Q4(intramuscular approach):within the muscle tissue of the quadratus lumborum;Group C(control group):no nerve block administered.Comparing the intraoperative opioid dosage,postoperative visual analog scale(VAS)scores,and incidence of postoperative adverse events across the five groups.Results There was a statistically significant difference in the intraoperative dosage of sufentanil and remifentanil among the five groups(P<0.05).The intraoperative doses of sufentanil[(5.63±4.96),(3.13±3.70),(1.25±2.47),(6.25±5.40)μg]and remifentanil[(1.41±0.29),(1.22±0.25),(0.83±0.20),(1.62±0.28)mg]in Groups Q1,Q2,Q3 and Q4 were significantly lower than those in the group C[(9.38±5.79)μg and(2.05±0.37)mg],and the intraoperative doses of sufentanil and remifentanil in Group Q3 were significantly lower than those in Groups Q1,Q2 and Q4,with statistically significant differences(P<0.05).However,there was no significant difference in the intraoperative propofol dosage among the five groups(P>0.05).The resting and dynamic VAS scores immediately after surgery,6 h after surgery,12 h after surgery,and 24 h after surgery in Groups Q1,Q2,Q3 and Q4 were significantly lower than those in Group C.Moreover,Group Q3 had lower scores than Groups Q1,Q2 and Q4,with statistically significant differences(P<0.05).The incidence of postoperative adverse events(nausea/vomiting,urinary retention,muscle weakness,sensory loss)was low across all five groups,with no significant differences observed(P>0.05).Conclusion All four quadratus lumborum block approaches provide effective analgesia and reduce opioid consumption,with the anterior approach being the most effective.
作者
王梅静
韦余琴
任善洁
刘幸幸
WANG Mei-jing;WEI Yu-qin;REN Shan-jie(Department of Anesthesiology,Jinan Third People's Hospital,Jinan 250102,China)
出处
《中国实用医药》
2026年第7期36-40,共5页
China Practical Medicine
基金
山东大学卫健委基金(项目编号:2023-2-66)。
关键词
超声引导
腰方肌阻滞入路
腹腔镜全子宫切除术
镇痛效果
Ultrasound-guided
Quadratus lumborum block approaches
Laparoscopic total hysterectomy
Analgesic effects
