腰方肌阻滞与腹横肌平面阻滞用于腹腔镜结肠癌根治术患者术后镇痛的临床研究

The Effect of Quadratus Lumborum Block versus Transversus Abdominis Plane Block in Patients Undergoing Laparoscopic Radical Resection for Colon Cancer

目的评价腰方肌阻滞与腹横肌平面阻滞应用于腹腔镜结肠癌根治术患者术后镇痛的有效性与安全性。方法选取2019年1月~2021年1月拟于我院行腹腔镜结肠癌根治术的患者共计120例。纳入标准:年龄48~75岁,性别不限,ASAⅡ~Ⅲ级,体质指数(body mass index,BMI)18.5~27.9 kg/m^(2),行腹腔镜结肠癌根治术,同意参与本试验并签署知情同意书。患者随机纳入腰方肌阻滞组(Q组)和腹横肌平面阻滞组(T组),最终每组各纳入56例患者。Q组患者行腰方肌阻滞;T组患者行腹横肌平面阻滞。使用疼痛数字评分(numerical rating scale,NRS)评价两组患者麻醉后复苏室(postanesthesia care unit,PACU)内、术后2 h、8 h、24 h疼痛程度,并使用BCS舒适评分评价患者术后咳嗽、深呼吸时的舒适度。使用改良Bromage评分评价患者术后运动功能。记录术后24 h内两组患者PCIA按压次数、补救镇痛率以及手术后恶心呕吐(postoperative nausea and vomiting,PONV)、头晕、下肢运动阻滞等不良反应发生率。结果Q组患者术后2 h、8 h、24 h NRS评分均显著低于T组患者,差异有统计学意义(P<0.05)。Q组患者PACU内、术后2 h、8 h、24 h Bromage评分显著高于T组患者,差异有统计学意义(P<0.05)。Q组患者PACU内、术后2 h、8 h、24 h BCS评分显著高于T组患者,差异有统计学意义(P<0.05)。Q组患者PCIA按压次数、补救镇痛率均显著低于T组患者,差异有统计学意义(P<0.05)。Q组患者术后24 h内PONV、头晕发生率显著低于T组患者,但下肢运功阻滞发生率则显著高于T组患者,差异有统计学意义(P<0.05)。两组患者术后尿潴留发生率差异无统计学意义(P>0.05)。结论腰方肌阻滞用于腹腔镜结肠癌根治术患者术后镇痛效果优于腹横肌平面阻滞,但会影响患者下肢运动功能。

Objective To evaluated the effect of quadratus lumborum block versus transversus abdominis plane block in patients undergoing laparoscopic radical resection of colon cancer.Methods A total of 120 patients who planned to undergo laparoscopic radical resection of colon cancer in our hospital from January 2019 to January 2021 were selected.Inclusion criteria:48~75 years old,no gender limit,ASAⅡ~Ⅲgrade,body mass index(BMI)18.5~27.9 kg/m^(2),laparoscopic radical resection of colon cancer,agreement of the participationion with signature.The patients were randomly divided into the quadratus lumborum block group(group Q)and the transverse abdominis plane block group(group T)with 52 patients in each.The numerical evaluation scale(NRS)was used to evaluate the pain degree of the two groups of patients in the PACU,2h,8h,and 24h after the operation,and the BCS comfort score(BCS)was used to evaluate the pain degree of the patients during postoperative activities.The modified Bromage score was used to evaluate the postoperative motor function.The number of PCIA compressions,the rate of remedial analgesia,and the incidence of postoperative nausea and vomiting(PONV),dizziness,lower limb motor block and other adverse reactions were recorded within 24 hours.Results NRS scores in group Q at 2h,8h and 24h after surgery were significantly lower than that of group T(P<0.05).The Bromage scores in group Q in PACU,2h,8h and 24h after surgery were significantly higher than that of group T(P<0.05).BCS scores in group Q within PACU,2h,8h and 24h after surgery were significantly higher than that of group T(P<0.05).The times of PCIA compression and the rate of remedial analgesia in group Q were significantly lower than that of group T(P<0.05).The incidence of PONV and dizziness within 24 hours after surgery in group Q was significantly lower than that of group T,but the incidence of lower limb movement block was significantly higher(P<0.05).There was no significant difference in the incidence of postoperative urinary retention between 2 groups(P<0.05).Conclusion The analgesic effect of quadratus lumborum block is better than that of transverse abdominis muscle block in patients undergoing laparoscopic radical resection of colon cancer,but it will affect the lower limb motor function of patients.