弓状韧带上腰方肌阻滞对腹腔镜胆囊切除患者术后恢复质量的影响

Effect of supra arcuate-quadrat lumborum block on postoperative recovery quality in patients with laparoscopic cholecystectomy

目的观察弓状韧带上腰方肌阻滞(SA-QLB)对腹腔镜胆囊切除患者术后恢复质量的影响。方法选择2022年1月至4月厦门大学附属东方医院收治的择期全麻下行腹腔镜胆囊切除术患者60例,采用随机数字表法分为对照组(C组)和SA-QLB组,每组30例。SA-QLB组于麻醉诱导前在超声引导下行双侧SA-QLB,C组不行神经阻滞。两组均采用静吸复合麻醉,术后均使用患者自控镇痛。比较两组术中丙泊酚和瑞芬太尼用量;比较两组术后2、6、12、24 h和48 h时上腹部和肩部静息与咳嗽时视觉模拟评分法(VAS)评分;比较两组术后48 h内镇痛泵有效按压次数,补救镇痛率,恶心、呕吐发生率,尿潴留发生率,首次下床时间,首次排气时间;比较两组手术前后40项恢复质量量表(QoR-40)评分。结果术后2、6、12、24 h和48 h时,SA-QLB组上腹部和肩部静息与咳嗽时VAS评分低于C组(P<0.05)。SA-QLB组丙泊酚和瑞芬太尼用量少于C组;镇痛泵有效按压次数,补救镇痛率,恶心、呕吐发生率低于C组,首次下床时间、首次排气时间短于C组(P<0.05)。两组尿潴留发生率比较,差异无统计学意义(P>0.05)。术后24、48 h时,SA-QLB组QoR-40量表各项评分和总分高于C组(P<0.05)。结论SA-QLB可提高腹腔镜胆囊切除患者术后恢复质量。

Objective To observe the effect of supra arcuate-quadratus lumborum block(SA-QLB)on postoperative recovery quality of patients with laparoscopic cholecystectomy.Methods A total of 60 patients undergoing laparoscopic cholecystectomy under elective general anesthesia admitted to Dongfang Hospital Affiliated to Xiamen University from January to April 2022 were selected,they were divided into control group(group C)and SA-QLB group,with 30 cases in each group.SA-QLB group underwent bilateral SA-QLB under ultrasound guidance before anesthesia induction,and group C did not have nerve block.Both groups were treated with combined intravenous-inhalational anesthesia,and patient-controlled analgesia was used after operation.The intraoperative dosage of Propofol and Remifentanil,anesthesia time,and operation time were compared between two groups;visual analogue scale(VAS)scores at rest and cough in upper abdomen and shoulder were compared between two groups at 2,6,12,24 h,and 48 h after operation;the number of effective analgesic pump compressions,the rate of relief analgesia,the incidence of nausea and vomiting,the incidence of urinary retention,the first time to get out of bed,the first time to exhaust gas were compared between two groups within 48 h after operation;and the scores of the 40-item quality of recovery scale(QoR-40)before and after operation were compared between two groups.Results At 2,6,12,24 h,and 48 h after operation,VAS scores of rest and cough in upper abdomen and shoulder in SA-QLB group were lower than those in group C(P<0.05).The dosages of Propofol and Remifentanil in SA-QLB group were lower than those in group C;the number of effective analgesic pump compressions,the rate of relief analgesia,the incidence of nausea and vomiting were lower than those of group C,and the first time to get out of bed,the first time to exhaust gas were shorter than those of group C(P<0.05).There was no significant difference in the incidence of urinary retention between two groups(P>0.05).The grading scores and total scores of QoR-40 in SA-QLB group were higher than those in group C at 24 and 48 h after operation(P<0.05).Conclusion SA-QLB can improve the postoperative recovery quality of patients undergoing laparoscopic cholecystectomy.