超声引导下腰方肌阻滞对老年腹部手术患者围手术期神经认知障碍及术后镇痛效果的影响

Effect of ultrasound-guided quadratus lumborum block on perioperative neurocognitive disorders and postoperative analgesia in elderly patients undergoing abdominal surgery

目的观察超声引导下腰方肌阻滞(QLB)对老年腹部手术患者围手术期神经认知障碍(PND)及镇痛效果的影响。方法选择老年腹部手术患者60例,随机分为腰方肌阻滞联合全身麻醉组(Q组)和全身麻醉组(A组),各30例。Q组全身麻醉前行超声引导下QLB,A组单纯行全身麻醉。患者于手术前后采用简易精神状态检查表(MMSE)、谵妄评定方法中文修订版(CAM-CR)、日常生活活动(ADLs)量表分别评估认知状态、术后谵妄(POD)的发生、患者生活活动能力。记录麻醉药物用量、首次下床活动时间、排气排便时间;术后24h镇痛泵按压次数、吗啡用量;术后视觉模拟评分(VAS)、疼痛数字评分(NRS)、舒适评分(BCS)。结果与A组比较,Q组术后7天内POD发生率降低(P<0.01);术中丙泊酚和瑞芬太尼使用量减少(P<0.01);术后24h镇痛泵按压次数(P<0.01)、吗啡用量减少(P<0.05);术后1~5天VAS和术后1~6天NRS评分更低(P<0.01);术后1~6天BCS评分更高(P<0.05);术后1~4天镇痛满意度更高(P<0.01)。结论QLB可减少老年腹部手术患者术后PND的发生,增强术后镇痛效果,加速胃肠功能恢复。

Objective To observe the effect of ultrasound-guided quadratus lumborum block(QLB)on perioperative neurocognitive disorders(PND)and analgesia in elderly patients undergoing abdominal surgery.Methods 60 cases of elderly patients with abdominal surgery were randomly divided into the quadratus lumborum block combined with general anesthesia group(group Q)and general anesthesia group(group A),with 30 cases in each group.Cognitive status,POD occurrence and living activity ability of patients were assessed by Mini-mental state examination(MMSE),the confusion assessment method-Chinese reversion(CAM-CR)and activities of daily livin(g ADLs)before and after operation.Recorded the usage of anesthetic drugs,the time of first off-bed exercise,exhaust and defecation time,the press times of analgesic pump 24h after operation,morphine dosage,postoperative VAS,NRS and BCS.Results Compared with group A,the incidence of POD in group Q within 7 days after operation decreased(P<0.01);the usage amount of propofol and remifentanil during operation decreased(P<0.01);the press times of analgesia pump and the usage amount of morphine 24h after operation decreased(P<0.05).Compared with group A,VAS at 1~5 days and NRS at 1~6 days after operation were lower(P<0.01),BCS at 1~6 days after surgery were higher,postoperative analgesia satisfaction at 1~4 days after operation were higher(P<0.05)in group Q.Conclusion QLB can reduce the incidence of PND after abdominal surgery in elderly patients,enhance postoperative analgesic effect,and accelerate the recovery of gastrointestinal function.