腹腔镜全子宫切除术经弓状韧带上腰方肌阻滞与前路腰方肌阻滞麻醉效果对比

Comparison of the anesthetic effect of the quadratus lumborum block by lateral supra-arcuate ligament and anterior quadratus lumborum block during the total laparoscopic hysterectomy

目的:比较经弓状韧带上腰方肌阻滞(QLB-LSAL)与前路腰方肌阻滞(QLB)在腹腔镜全子宫切除术麻醉中的应用效果。方法:回顾性选取2019年1月-2021年10月在本院择期行腹腔镜全子宫切除术患者80例,根据阻滞方式的不同分为QLB-LSAL组(L组,n=49)和前路QLB组(Q组,n=31)。记录两组围术期指标,对比两组术后不同时点的静息及活动时的觉模拟评分(VAS),切皮前后心率(HR)和平均动脉压(MAP)变化情况及不良事件发生情况。结果:L组(8.2%)和Q组(12.9%)不良事件发生率无差异(P>0.05)。L组阻滞后起效时间(6.58±2.24min)、首次下床活动时间(13.04±2.12h)和住院时间(9.14±0.86d)均短于Q组(9.78±3.07min、16.69±2.64h、9.57±0.35d)(P<0.05),但两组阻滞操作时间无差异(P>0.05)。术后2 h、6 h、12 h两组静息和活动时的VAS评分均逐渐升高但L组低于Q组(P<0.05);切皮前5min时,两组MAP、HR水平无差异(P>0.05),切皮后5min时L组MAP(90.33±8.91 mmHg)、HR(78.96±6.37次/min)水平均低于Q组(96.42±9.04 mmHg、84.61±6.15次/min)(P<0.05)。结论:相较于前路QLB,QLB-LSAL在腹腔镜全子宫切除术中的镇痛效果更佳,能维持血流动力学稳定,优化围术期指标,促进术后恢复。

Objective:To compare the anesthetic effect of the quadratus lumborum block by lateral supra-arcuate ligament(QLB-LSAL)and anterior quadratus lumborum block(QLB)during the total laparoscopic hysterectomy.Methods:80patients who had been elective total laparoscopic hysterectomy between January 2019and October 2021were selected retrospectively.According to the different block methods,these patients were divided into group A(49patients with QLB-LSAL)and group B(31patients with anterior QLB).The perioperative indexes of the patients in both groups were recorded.The scores of visual analogue scale(VAS)of the patients at rest and action states in different time points after surgery were compared between the two groups.The changes of the values of heart rate(HR)and mean arterial pressure(MAP)of the patients before and after skin incision,and the occurrence of adverse events of the patients were compared between the two groups.Results:There was no significant difference in the incidence of adverse events(8.2%vs.12.9%)of the patients between the two groups(P>0.05).The onset time of block(6.58±2.24min),the first time of getting out of bed(13.04±2.12h),and the duration of hospital stay(9.14±0.86d)of the patients in group A were significantly shorter than those(9.78±3.07min,16.69±2.64h,and 9.57±0.35d)of the patients in group B(P<0.05).However,there was no significant difference in the time of block operation of the patients between the two groups(P>0.05).The VAS scores of the patients in the two groups at rest and action states in 2h,6h,and 12hafter surgery had increased gradually,but which of the patients in group A were significantly lower than those of the patients in group B(P<0.05).There were no significant differences in the MAP and HR values of the patients at 5min before skin incision between the two groups(P>0.05).The values of MAP(90.33±8.91mmHg)and HR(78.96±6.37times/min)of the patients in group A at 5min after skin incision were significantly lower than those(96.42±9.04mmHg and 84.61±6.15times/min)of the patients in group B(P<0.05).Conclusion:Compared with those of anterior QLB,QLB-LSAL used in total laparoscopic hysterectomy of the patients has better analgesic effect,which can maintain the hemodynamic stability,optimize perioperative indexes,and promote the postoperative recovery anterior.