超声引导下后路腰方肌阻滞对腹腔镜全子宫切除术患者术后镇痛效果及炎性反应的影响

Effects of ultrasound-guided posterior quadratus lumborum block on post-operative analgesia and inflammatory response in laparoscopic hysterectomy patients

目的:探讨超声引导下后路腰方肌阻滞(QLB2)对腹腔镜全子宫切除术患者术后镇痛效果及炎性反应的影响。方法:选取2017年6月-2019年7月宜宾市第一人民医院妇科全麻行腹腔镜全子宫切除术患者106例为研究对象,采用随机数字表法将其分为QLB2组(Q组)和对照组,各53例。Q组于全麻诱导后行QLB2,对照组只行全麻。比较两组瑞芬太尼的总用量、罗库溴铵追加剂量、补救性镇痛次数及首次按压镇痛泵时间、苏醒指标、首次下床时间、首次肛门排气时间及住院时间;比较两组术后2 h、4 h、8 h、12 h、 24 h两组静态和动态时VAS评分;比较给药前、术毕、术后4 h、24 h(T1、T2、T3、T4)两组血清白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平。结果:Q组瑞芬太尼用量、罗库溴铵追加剂量小于对照组(P <0.05);Q组患者首次按压镇痛泵时间晚于对照组(P <0.05);Q组患者补救性镇痛次数少于对照组(P <0.05);在术后2 h、4h、8 h、12 h、24 h时,Q组静态和动态VAS评分低于对照组(P <0.05);Q组苏醒、自主呼吸恢复、拔除喉罩时间短于对照组(P <0.05);在T2、T3、T4时,Q组血清IL-6、TNF-α水平低于对照组(P <0.05);Q组首次下床时间、首次肛门排气时间早于对照组(P <0.05);Q组住院时间短于对照组(P <0.05)。结论:QLB2复合全麻用于腹腔镜子宫切除术患者能减少麻醉药物用量,有效减少促炎因子的分泌和改善术后镇痛效果,促进早期康复。

Objective:To explore the effects of ultrasound-guided posterior quadratus lumborum block(QLB2)on post-operative analgesia and inflammatory response in patients undergoing laparoscopic hysterectomy surgery.Methods:106 patients with total laparoscopic hysterectomy in gynaecology of the First People's Hospital of Yibin from June 2017 to July 2019 were selected as the subjects.According to the random digital table method,106 patients were divided into QLB2(Q)group and control group,53 cases in each group.The patients of Q group received ultrasound-guided bilateral posterior quadratus lumborum block(QLB2)after induction of general anesthesia while the control group only received general anesthesia.The total dosage of remifentanil,the additional dose of rocuronium,the times of remedial analgesia,the time of first pressing analgesia pump,the indexes of recovery,the time of first getting out of bed,the time of first anal exhaust and the time of hospitalization were compared between the two groups.The VAS scores in static and dynamic state at 2 h,4 h,8 h,12 h and 24 h after operation were compared between the two groups.The inflammatory factors(IL-6,TNF-α)were monitored before administration,at the end of operation,4 h after operation and 24 h after operation(T1,T2,T3,T4).Results:The dosage of remifentanil and the additional dosage of rocuronium in Q group were lower than those in the control group(P<0.05).The first time of pressing analgesia pump in group Q was later than that in control group(P<0.05).The times of remedial analgesia in group Q was less than that in control group(P<0.05).The VAS scores in static and dynamic state in Q group at 2 h,4 h,8 h,12 h and 24 h after operation were lower than those in the control group(P<0.05).The recovery time,recovery time of spontaneous respiration and recovery time of laryngeal mask in group Q were shorter than that in control group(P<0.05).The serum IL-6,TNF-αin Q group at T2,T3,T4 were lower than those in the control group(P<0.05).The first time of getting out of bed and the first time of anal exhaust in group Q was earlier than that in control group(P<0.05).The hospitalization time of Q group was shorter than that of control group(P<0.05).Conclusion:QLB2 combined with general anesthesia can reduce the dosage of anesthetic,effectively reduce the secretion of pro-inflammatory factors,improve postoperative analgesia and promote early rehabilitation in patients with laparoscopic total hysterectomy.