超声引导下腰方肌阻滞在腹腔镜结直肠癌根治术快速康复中应用的临床研究

Clinical study on the application of ultrasound-guided quadratus lumborum block in the rapid rehabilitation of laparoscopic radical resection of colorectal cancer

目的:观察超声下腰方肌阻滞(QLB)对腹腔镜结直肠癌根治术术后快速康复的临床效果。方法:选取我院90例行腹腔镜结直肠癌根治术的患者,随机分为QLB组和腹横肌平面阻滞(TAPB)组,每组各45例。两组分别行双侧超声引导下QLB和TAPB,予舒芬太尼行静脉患者自控镇痛(PCIA)。对比两组患者舒芬太尼用量、疼痛视觉模拟评分(VAS)、静脉镇痛泵使用及术后康复情况。结果:TAPB组术中、术后2 h、术后12h、术后24 h和术后48 h舒芬太尼用量均高于QLB组同时期用量,差异有统计学意义。QLB组术后2 h、术后6h、术后12 h、术后32 h和术后48 h VAS评分均低于TAPB组同时期评分。术后QLB组首次按压PCIA时间、术后24 h和术后48hPCIA按压次数以及舒芬太尼用量均低于TAPB组。QLB组苏醒时间、肛门排气时间、下床活动时间、住院时间及不良反应发生率均低于TAPB组,而镇痛满意度评分高于TAPB组。结论:腹腔镜结直肠癌根治术前给予超声下腰方肌阻滞,能够起到更好的镇痛效果且安全性良好,更利于患者术后康复。

Objective To observe the clinical effect of ultrasonic quadratus lumborum block(QLB)on rapid recovery after laparoscopic radical resection of colorectal cancer.Methods 90 patients undergoing laparoscopic radical resection of colorectal cancer in our hospital were selected and randomly divided into QLB group and transversus abdominis plane block(TAPB)group,with 45 cases in each group.The two groups underwent bilateral ultrasound-guided QLB and TAPB,and sufentanil for intravenous patient-controlled analgesia(PCIA).Compare the dosage of sufentanil,the visual analogue scale(VAS)of pain,the use of rapid analgesic pump and the postoperative rehabilitation of the two groups of patients.Results The dosage of sufentanil during operation,2 hours after operation,12 hours after operation,24 hours after operation,and 48 hours after operation in the TAPB group was higher than that in the QLB group during the same period,and the difference was statistically significant.The VAS scores of the QLB group at 2 h,6 h,12 h,32 h and 48 h after the operation in the QLB group were lower than those in the TAPB group during the same period.The time of PCIA compression for the first time in the QLB group,the number of PCIA compressions at 24 h and 48 h after surgery,and the amount of sufentanil in the QLB group were all lower than those in the TAPB group.The QLB group’s wake-up time,anal exhaust time,time to get out of bed,hospital stay and the incidence of adverse reactions were lower than those of the TAPB group,and the analgesic satisfaction score was higher than that of the TAPB group.Conclusion Before laparoscopic colorectal cancer radical resection,the ultrasound lower quadratus lumborum block can have better analgesic effect and good safety,which is more conducive to the recovery of patients after surgery.