超声引导下腰方肌阻滞在全麻髋关节置换术中对患者疼痛、炎性因子及生命体征的影响

Effect of ultrasound-guided quadratus lumborum block on patients’pain,inflammatory factors and vital signs during hip replacement under general anesthesia

目的探讨超声引导下腰方肌阻滞在全麻髋关节置换术中的应用及其对患者疼痛、炎性因子及生命体征的影响。方法按随机数字表法将2019年5月至10月在重庆医科大学附属第一医院行全麻髋关节置换术的120患者分为观察组(60例)与对照组(60例)。对照组患者接受常规麻醉,观察组患者采用超声引导下腰方肌阻滞,两组患者均术后观察48 h。比较两组患者麻醉和手术指标,术后6、12、24 h视觉模拟疼痛量表(VAS)评分,术前与术后24、48 h炎性因子水平,术前与术后6、12 h平均动脉压(MAP)、心率(HR)水平,不良反应发生率。结果观察组患者术后静脉镇痛药量、术后追加镇痛药物次数显著少于对照组(均P<0.05);两组患者手术时间、术中出血量、苏醒时间相比,差异均无统计学意义(均P>0.05);与术前比,两组患者术后24~48 h血清IL-6、CRP均呈先升后降趋势,且观察组患者术后24~48 h显著低于对照组(均P<0.05);与术前比,观察组患者术后6~12 h MAP水平呈先降后升趋势,对照组患者术后6~12 h MAP、HR水平均呈逐渐升高趋势,且观察组术后6~12 h MAP、HR水平显著低于对照组(均P<0.05);两组患者术后6~24 h VAS评分均呈先升后降趋势,且观察组术后6~24 h VAS评分均显著低于对照组(均P<0.05);观察组患者不良反应总发生率为4.91%,显著低于对照组的25.00%(P<0.05)。结论超声引导下腰方肌阻滞用于髋关节置换术麻醉效果显著且具有较高的镇痛效果,同时能缓解患者术后炎症状态,减轻应激反应,益于维持患者生命体征,安全性高。

Objective To study effect of ultrasound-guided quadratus lumborum block on patients'pain,inflammatory factors and vital signs during hip replacement under general anesthesia.Methods According to the random number table method,120 patients who underwent hip replacement under general anesthesia in the First Affiliated Hospital of Chongqing Medical University from May to October 2019 were divided into the observation group(60 cases)and the control group(60 cases).Patients in the control group received conventional anesthesia,patients in the observation group underwent ultrasound-guided quadratus lumbar muscle block,both groups were observed 48 hours after operation.Anesthesia indexes,visual analog scale(VAS)scores at 6,12 and 24 h after operation,inflammatory factor levels at 24 and 48 h before operation,mean arterial pressure(MAP)and heart rate(HR)levels at 6 and 12 h after operation,and the incidence of adverse reactions were compared between the two groups.Results The amount of intravenous analgesics and the number of additional analgesics of the observation group were significantly less than those of the control group(all P<0.05);There was no statistically significant difference between the two groups of patients in operation time,intraoperative blood loss,and recovery time(all P>0.05);Compared with preoperatively,the serum IL-6 and CRP of the two groups of patients increased first and then decreased after 24~48 h after surgery,and the observation group was significantly lower than the control group at 24 h and 48 h after operation(all P<0.05);Compared with preoperatively,the MAP and HR levels of the observation group decreased first and then increased at 6~12 h after operation,the MAP levels of the observation group were significantly lower than those of the control group at 6~12 h after operation(all P<0.05);The VAS scores of the two groups of patients increased first and then decreased after 6~24 h,and the VAS score of the observation group was significantly lower than that of the control group at 6~24 h after operation(all P<0.05);The total incidence of adverse reactions of the observation group was 4.91%,which was significantly lower than 25.00%of the control group(P<0.05).Conclusion Ultrasound-guided quadratus lumborum block has a significant anesthetic effect and a high analgesic effect in hip arthroplasty under general anesthesia,At the same time,it can relieve the postoperative inflammation of the patient,reduce the stress response,and help maintain the patient's vital signs,with high safety.