超声引导下腰方肌阻滞联合舒芬太尼或羟考酮在腹腔镜全子宫切除术后自控静脉镇痛的效果

The Effect of Ultrasound-guided Quadratus Lumbar Muscle Block Combined with Sufentanil or Oxycodone in Patient-controlled Intravenous Analgesia after Laparoscopic Hysterectomy

目的探讨超声引导下腰方肌阻滞(QLB)联合舒芬太尼或羟考酮在腹腔镜全子宫切除术(LTH)后自控静脉镇痛(PCIA)的效果。方法选择2019年6月—2021年6月于该院行LTH治疗的78例患者,按随机数字表法将其分为QLB联合舒芬太尼(S)组(BS组)与QLB联合羟考酮(O)组(BO组),各39例。BS组采用超声引导下QLB联合舒芬太尼PCIA,BO组采用超声引导下QLB联合羟考酮PCIA。比较两组镇痛效果、48 h内PCIA累计用量、有效按压次数及补救镇痛情况、不良反应、镇痛满意度。结果BO组术后4、8、12、24 h时视觉模拟评分法(VAS)评分为(1.76±0.52)分、(1.98±0.86)分、(1.68±0.47)分、(1.02±0.34)分低于BS组,差异有统计学意义(t=8.827、5.367、6.044、7.096,P<0.05);BO组48 h内PCIA累计用量、有效按压次数少于BS组,差异有统计学意义(P<0.05);BO组不良反应总发生率(5.13%)低于BS组,差异有统计学意义(χ^(2)=5.186,P<0.05);BO组镇痛满意度(94.87%)高于BS组,差异有统计学意义(P<0.05);两组补救镇痛发生率比较,差异无统计学意义(P>0.05)。结论在LTH术后采用超声引导下QLB联合羟考酮PCIA镇痛效果更佳,患者疼痛强度轻微,可减少镇痛药物用量及不良反应的发生,提高患者镇痛满意度,临床应用安全、有效。

Objective To investigate the effect of ultrasound-guided quadratus lumborum block(QLB) combined with sufentanil or oxycodone in patient-controlled intravenous analgesia(PCIA) after laparoscopic total hysterectomy(LTH).Methods 78 patients who underwent LTH treatment in the hospital from June 2019 to June 2021 were selected.According to the random number table,they were divided into QLB combined with sufentanil(S) group(BS group) and QLB combined with oxycodone(0) group(BO group),each with 39 cases.The BS group received ultrasound-guided QLB combined with sufentanil PCIA,and the BO group received ultrasoundguided QLB combined with oxycodone PCIA.The analgesic effect,the cumulative amount of PCIA within 48 h,the number of effective compressions,the status of remedial analgesia,adverse reactions,and satisfaction with analgesia were compared between the two groups.Results Visual analogue scoring(VAS) scores(1.76±0.52) points,(1.98±0.86) points,(1.68±0.47) points,(1.02±0.34) points in the BO group at 4 h,8 h,12 h and 24 h after operation lower than the BS group,the difference was statistically significant(t=8.827,5.367,6.044,7.096,P<0.05).The cumulative amount of PCIA and the number of effective compressions in the BO group within 48 h were less than those in the BS group,the difference was statistically significant(P<0.05).The total incidence of adverse reactions in the BO group(5.13%) was lower than that in the BS group,the difference was statistically significant(χ^(2)=5.186,P<0.05).The satisfaction degree of analgesia in the BO group(94.87%) was higher than that in the BS group,the difference was statistically significant(P<0.05).Compared the incidence of salvage analgesia between the two groups,the difference was not statistically significant(P>0.05).Conclusion Ultrasound-guided QLB combined with oxycodone PCIA has a better analgesic effect after LTH surgery.The pain intensity of patients is mild,which can reduce the dosage of analgesic drugs and the occurrence of adverse reactions,and improve the satisfaction of patients with analgesia.Clinical application is safe and effective.