不同入路腰方肌阻滞对腹腔镜直肠癌根治术患者术后的镇痛效果的影响

Effects of different approaches of quadratus lumborum block on postoperative analgesia in patients undergoing laparoscopic radical rectal cancer surgery

目的对比不同入路腰方肌阻滞(quadratus lumbar muscle block,QLB)对腹腔镜直肠癌根治术患者术后的镇痛效果。方法选取本院收治的拟行腹腔镜直肠癌根治术治疗的直肠癌患者128例,采用随机数字表法分为前路组(QLB腰方肌与腰大肌之间的筋膜平面入针)、外侧路组(QLB外侧入针)、后路组(QLB后路入针)和对照组(常规静脉自控镇痛),每组各32例。对比4组患者术后首次按压静脉自控镇痛(patient-controlled intravenous analgesia,PCIA)时间、首次排气时间和下床活动时间。对比4组患者术后不同时刻视觉模拟评分(visual analog scale,VAS)评分。对比四组患者PCIA有效按压次数、术后24 h内舒芬太尼总用量。对比4组患者术后不良反应。结果前路组、外侧路组及后路组3组首次按压PCIA时间均长于对照组(P<0.05),首次排气和首次下床活动则均短于对照组(P<0.05)。VAS评分在组间、时点间及组间时点间交互作用比较差异均有统计学意义(P<0.05)。前路组、外侧路组及后路组3组PCIA有效按压次数、术后24 h内舒芬太尼总用量均低于对照组(P<0.05);前路组术后PCIA有效按压次数、术后24 h内舒芬太尼总用量又均低于外侧路组和后路组(P<0.05)。前路组、外侧路组及后路组3组术后不良反应总发生率均低于对照组(P<0.05)。结论超声引导下不同入路QLB均可促进患者术后恢复、提高腹腔镜直肠癌根治术患者术后的镇痛效果、减少阿片类药物的用量,并可降低不良反应的发生率,但前路QLB在镇痛、减少术后镇痛药物使用量方面优于外侧路和后路QLB。

Objective To compare the analgesic effects of different approaches of quadratus lumbar muscle block(QLB)on patients undergoing laparoscopic radical resection of rectal cancer.Methods A total of 128 patients with rectal cancer who received laparoscopic radical resection of rectal cancer in our hospital were selected and divided into anterior approach group(injection of fascia plane between QLB psoas muscle and psoas major muscle,n=32),lateral approach group(external injection of QLB,n=32),posterior approach group(posterior injection of QLB,n=32)and control group[routine patient-controlled intravenous analgesia(PCIA),n=32].The first compression time of PCIA,the time of first exhaust and the first time of off-bed activity were compared among the four groups.The visual analog scale(VAS)scores were compared in the four groups at different time points after operation.The effective number of PCIA compression and the total amount of sufentanil within 24 h after surgery were compared among the four groups.The adverse reactions of the four groups were compared.Results The first compression time of PCIA in the anterior approach,lateral approach,and posterior approach groups was longer than that of the control group(P<0.05),and the first exhaust time and the first time of off-bed activity were shorter than those of the control group(P<0.05).The differences in VAS scores in interaction between groups,time points and time points between groups were statistically significant(P<0.05).The effective number of PCIA compression and the total amount of sufentanil within 24 h after surgery in the anterior approach,lateral approach and posterior approach groups were lower than those in the control group(P<0.05),and lower in the anterior approach group than in the lateral approach group and the posterior approach group(P<0.05).The total incidence of adverse reactions in the anterior approach,lateral approach and posterior approach groups was lower than that in the control group(P<0.05).Conclusion Different approaches of QLB guided by ultrasound can promote postoperative recovery of patients,improve the analgesic effect of patients after laparoscopicradical resection of rectal cancer,and reduce the dosage of opioids and the incidence of adverse reactions.However,QLB via anterior approach is superior to that via lateral approach and posterior approach in terms of analgesia and reduction of the amount of postoperative analgesics.