超声引导下双侧弓状韧带上腰方肌阻滞复合全身麻醉在腹腔镜下全子宫切除术中的应用观察

Application of Ultrasound-Guided Bilateral Quadratus Lumborum Block at Arcuate Ligaments Combined with General Anesthesia in Laparoscopic Total Hysterectomy

目的:探析超声引导下双侧弓状韧带上腰方肌阻滞复合全身麻醉用于腹腔镜下全子宫切除术患者中的麻醉意义。方法:选取2020年1-12月于湘乡市人民医院实施腹腔镜下全子宫切除术的100例患者为研究对象,ASA分级Ⅰ~Ⅱ级,采取随机抽签方式分为两组,各50例。观察组选取超声引导下双侧弓状韧带上腰方肌阻滞复合全身麻醉,对照组选取单纯插管全身麻醉。对比两组手术过程中丙泊酚、瑞芬太尼用药总量,术后2 h、6 h、12 h、24 h、48 h的静息痛视觉模拟评分(VAS)及补救镇痛次数,术后恶心呕吐发生率,不良反应发生率。结果:观察组手术过程中丙泊酚、瑞芬太尼用药总量均少于对照组,差异有统计学意义(P=0.000);观察组术后2 h、6 h、12 h、24 h、48 h的VAS均低于对照组,差异有统计学意义(P=0.000);观察组术后2 h、6 h、12 h、24 h、48 h的补救镇痛次数均少于对照组,差异有统计学意义(P=0.000);观察组术后恶心呕吐发生率低于对照组,差异有统计学意义(P=0.026);观察组不良反应发生率低于对照组,差异无统计学意义(P>0.05)。结论:为腹腔镜下全子宫切除术患者选择超声引导下双侧弓状韧带上腰方肌阻滞复合全身麻醉的麻醉效果良好。

Objective:To explore the anesthesia significance of ultrasound-guided bilateral quadratus lumborum block at arcuate ligaments combined with general anesthesia in patients undergoing laparoscopic total hysterectomy.Methods:A total of 100patients who underwent laparoscopic total hysterectomy in the People’ s Hospital of XiangXiang from January 2020 to December2020 were selected as the study subjects,with ASA Ⅰ-Ⅱ.By random drawing method,the patients were divided into two groups,with 50 cases in each group.The observation group was given ultrasound-guided bilateral quadratus lumborum block at arcuate ligaments combined with general anesthesia,and the control group was given simple intubation general anesthesia.The total amount of propofol and remifentanil used during the operation,the visual analogue score(VAS) of rest pain at 2 h,6 h,12 h,24 h and 48 h after surgery,the incidence of postoperative nausea and vomiting,and the incidence of adverse reactions in the two groups were compared.Results:The total amount of propofol and remifentanil used during the operation in the observation group was lower than that in the control group,and the difference was statistically significant(P=0.000).The VAS in the observation group at 2 h,6 h,12 h,24 h and 48 h after surgery was lower than that in the control group,and the difference was statistically significant(P=0.000).The number of rescue analgesia in the observation group at 2 h,6 h,12 h,24 h and 48 h after surgery was lower than that in the control group,and the difference was statistically significant(P=0.000).The incidence of postoperative nausea and vomiting in the observation group was lower than that in the control group,and the difference was statistically significant(P=0.026).The incidence of adverse reactions in the observation group was lower than that in the control group,and the difference was not statistically significant(P>0.05).Conclusion:Ultrasound-guided bilateral quadratus lumborum block at arcuate ligaments combined with general anesthesia in patients undergoing laparoscopic total hysterectomy has a better anesthesia effect.