探讨超声引导下腰方肌阻滞联合全身麻醉对妇科腔镜手术患者认知功能、疼痛及恢复质量的影响

Investigation on the effects of ultrasound-guided quadratus lumborum block combined with general anesthesia on cognitive function, pain and recovery quality in patients undergoing gynecological endoscopic surgery

目的 探讨超声引导下腰方肌阻滞(QLB)联合全身麻醉对妇科腔镜手术患者认知功能、疼痛及恢复质量的影响。方法 选择2021年1—10月本院收治的70例需择期行妇科腔镜手术患者作为研究对象,依照随机数表法分为观察组和对照组两组,每组各35例。对照组患者单纯应用全身麻醉,观察组患者在全麻诱导前30分钟应用超声引导下后路腰方肌区域神经阻滞。对比两组患者不同时间点血流动力学指标,疼痛程度和舒适度、术后认知功能以及恢复质量情况。结果 两组患者入室后、阻滞完成后平均动脉压(MAP)、心率(HR)比较,差异无统计学意义(P>0.05);观察组患者切皮时、拔管时MAP、HR均低于对照组,差异具有统计学意义(P<0.05);观察组患者苏醒后2小时、24小时的运动视觉模拟量表(VAS)评分和静息VAS评分明显低于对照组,差异具有统计学意义(P<0.05);且苏醒后24小时的运动VAS评分和静息VAS评分高于苏醒后2小时,差异具有统计学意义(P<0.05);观察组患者苏醒后2小时、24小时的舒适度(BCS)评分明显高于对照组,差异具有统计学意义(P<0.05);且苏醒后24小时BCS评分低于苏醒后2小时,差异具有统计学意义(P<0.05);观察组患者24小时内镇痛泵用量明显低于对照组,首次按压镇痛泵时间明显高于对照组,差异具有统计学意义(P<0.05);两组患者手术前简易智力状态检查量表(MMSE)评分比较,差异无统计学意义(P>0.05);两组患者术后24小时MMSE评分与手术前相比明显降低,而48小时、72小时后MMSE评分明显升高,且观察组患者48小时、72小时后MMSE评分高于对照组,差异具有统计学意义(P<0.05);两组患者术前恢复质量15项量表(QOR-15)评分比较,差异无统计学意义(P>0.05);两组患者术后第1天、第2天QOR-15评分与术前均降低,且观察组患者术后第1天、第2天QoR-15评分高于对照组,差异具有统计学意义(P<0.05);观察组患者认知功能障碍发生率及不良反应发生率明显低于对照组,差异具有统计学意义(P<0.05)。结论 对妇科腔镜手术患者应用超声引导腰方肌区域神经阻滞联合全身麻醉能够减轻患者术中血流动力学波动,减轻患者疼痛评分,提高舒适度,对认知功能影响较低,且术后恢复质量更好,值得临床应用推广。

Objective To investigate the effects of ultrasound-guided quadratus lumborum block combined with general anesthesia on cognitive function, pain and recovery quality of patients undergoing gynecological endoscopic surgery. Methods 70 patients who needed elective gynecological endoscopic surgery those were admitted to our hospital from January 2021 to October 2021 were selected as the research objects. They were randomly divided into observation group and control group, with 35 cases in each group. The patients in the control group were treated with general anesthesia only, and the patients in the observation group were treated with ultrasound-guided posterior lumbar quadratus regional nerve block 30 minutes before the induction of general anesthesia. The hemodynamic indexes, degree of pain and comfort, postoperative cognitive function and recovery quality of the two groups were compared at different times.Results There was no significant difference in mean arterial pressure(MAP) and heart rate(HR) after entering the room and the time the quadratus lumborum block finished(P>0.05). MAP and HR in the observation group were lower than those in the control group at skin incision and extubation(P<0.05). The scores of motor visual analogue scale(VAS) and resting VAS in the observation group at 2 h and 24 h after awakening were lower than those in the control group(P<0.05), and the VAS scores of exercise and rest at 24 hours after awakening were higher than that at 2 hours after awakening(P<0.05). The BCS scores at 2 hour and 24 hours after awakening in the observation group were significantly higher than those in the control group( P<0.05),and the BCS score at 24 hours after awakening was lower than that at2 hour after awakening( P<0.05). The amount of analgesic pump use in observation group was significantly lower than that in control group within 24h,and the time of first pressing analgesic pump was significantly higher than that in control group,the difference was statistically significant( P<0.05). There was no significant difference in the score of mini-mental state examination( MMSE) scale between the two groups before operation( P> 0.05).The MMSE scores at 24 hours after operation were significantly lower than that before operation,MMSE score increased significantly after 48h and 72h,and the MMSE scores at 48 and 72 hours after operation were higher in the observation group than that in the control group( P < 0. 05). There was no significant difference in score of quality of recover scale( QOR-15) between the two groups before operation( P> 0.05);the QOR-15 score of both two groups decreased on 1std and 2ndd after surgery and before surgery,and QOR-15 scores in the observation group were lower than those in the control group on the 1s t and 2n d day after operation( P<0.05). The incidence of cognitive dysfunction and adverse reactions in observation group was significantly lower than that in control group,with statistical significance( P<0.05).Conclusions The application of ultrasound-guided lumbar quadratus regional nerve block combined with general anesthesia in patients received gynecological endoscopic surgery could reduce the fluctuation of hemodynamic indexes,reduce the pain score,improve comfort,have a low impact on cognitive function and better postoperative recovery quality,which is worthy of clinical application and promotion.