后路腰方肌阻滞复合全身麻醉在腹股沟斜疝经腹腹膜前手术中的应用效果

Application effect of posterior quadratus lumborum block combined with general anesthesia during trans-abdominal preperitoneal surgery for indirect inguinal hernia

目的探究后路腰方肌阻滞(QLB)复合全身麻醉(全麻)对腹股沟斜疝(IIH)经腹腹膜前疝修补术(TAPP)患者围手术期应激和术中瑞芬太尼用量的影响。方法前瞻性选取临泉县人民医院2020年2月至2022年10月收治的94例IIH患者为研究对象,所有患者均行TAPP治疗,根据手术麻醉方式不同分为全麻组和复合麻醉组,各47例,全麻组行全麻,复合麻醉组在全麻前30 min行后路腰方肌阻滞麻醉,比较2组麻醉实施前(T0)、气管插管即刻(T1)、手术开始前(T2)、手术开始10 min后(T3)、手术结束即刻(T4)、拔管时(T5)血流动力学指标[平均动脉压(MAP)、心率及血氧饱和度(SpO_(2))]、麻醉苏醒质量、术中瑞芬太尼用量和术后补救镇痛情况、围手术期疼痛[视觉模拟评分法(VAS)]、应激反应[催乳素、血糖、生长激素]变化和不良反应发生情况。结果心率、MAP组间、时点、交互比较,差异均无统计学意义(P>0.05);复合麻醉组术后自主呼吸恢复时间、拔管时间、睁眼时间、定向力恢复时间均显著短于全麻组(P<0.05);复合麻醉组术中瑞芬太尼用量、术后48 h内镇痛泵有效按压次数、舒芬太尼用量均显著低于全麻组(P<0.05),2组术后48 h内补救镇痛例数比较,差异无统计学意义(P>0.05);VAS评分组间、时点、交互比较,差异均有统计学意义(P<0.05),术后组内和组间各时点比较,差异均有统计学意义(P<0.05);催乳素、血糖、生长激素组间、时点、交互比较,差异均有统计学意义(P<0.05),2组切皮后20 min、术后2 h血清催乳素、血糖、生长激素水平均显著高于麻醉前10 min(P<0.05),复合麻醉组切皮后20 min、术后2 h血清催乳素、血糖、生长激素水平均显著低于全麻组(P<0.05);2组不良反应发生率比较(8.51%vs 12.77%),差异无统计学意义(P>0.05)。结论后路QLB复合全麻用于IIH患者TAPP术麻醉有助于减少术中瑞芬太尼用量,辅助加强术后镇痛效果,减轻围手术期应激反应。

Objective To explore the effects of posterior quadratus lumborum block(QLB)combined with general anesthesia on perioperative stress and intraoperative remifentanil dosage in patients with indirect inguinal hernia(IIH)undergoing trans-abdominal preperitoneal hernia repair(TAPP).Methods Ninety-four patients with IIH admitted to Linquan County People's Hospital from February 2020 to October 2022 were selected as subjects.All patients were treated with TAPP surgery.According to the different anesthesia methods,the patients were divided into general anesthesia group and combined anesthesia group,with 47 cases in each group.The general anesthesia group received general anesthesia,and the combined anesthesia group received posterior QLB 30 min before general anesthesia.Hemodynamic indicators[mean arterial pressure(MAP),heart rate(HR)and oxygen saturation(SpO_(2))]before the implementation of anesthesia(T0),immediately after tracheal intubation(T1),before the beginning of surgery(T2),10 min after the beginning of surgery(T3),immediately after the end of surgery(T4)and at the time of extubation(T5),anesthesia recovery quality,intraoperative remifentanil dosage and postoperative remedial analgesia,perioperative pain[Visual Analogue Scale(VAS)],stress response[prolactin(PRL),blood glucose(Glu),growth hormone(GH)]and occurrence of adverse reactions were compared between the two groups.Results There were no statistical differences in HR and MAP from the aspects of between-group effect,time-point and interaction of between-group×time-point(P>0.05).The postoperative spontaneous breathing recovery time,extubation time,eye opening time and orientation recovery time in combined anesthesia group were significantly shorter than those in general anesthesia group(P<0.05).The intraoperative remifentanil dosage,frequency of effective compressions of analgesic pump and sufentanil dosage within 48 h after surgery were significantly lower in combined anesthesia group than those in general anesthesia group(P<0.05).There was no statistical difference in the number of remedial analgesia between the two groups within 48 h after surgery(P>0.05).There was a statistical difference in VAS score from the aspects of between-group effect,time-point and interaction of between-group×time-point(P<0.05),and there was a statistically significant difference in VAS score within and between the groups at different time points after surgery(P<0.05).There were statistical differences in the levels of PRL,Glu and GH between groups,at different time points and between groups×time points(P<0.05).The levels of PRL,Glu and GH in the two groups 20 min after skin incision and 2 h after surgery were significantly higher than those 10 min before anesthesia(P<0.05),and serum levels of PRL,Glu and GH in combined anesthesia group were significantly lower than those in general anesthesia group 20 min after skin incision and 2 h after surgery(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(8.51%vs 12.77%,P>0.05).Conclusion Posterior QLB combined with general anesthesia for anesthesia of IIH patients undergoing TAPP is helpful to reduce intraoperative remifentanil dosage,enhance postoperative analgesia effect,and relieve perioperative stress response.