超声引导下不同区域阻滞用于老年人腹股沟疝修补术后镇痛的效果比较

Analgesic effect of different regional block techniques guided by ultrasound in older adult patients undergoing inguinal hernia repair surgery

目的比较老年人腹股沟疝修补术后实施超声引导下腹横肌平面阻滞与腰方肌阻滞的镇痛效果。方法选取2019年4月至2022年5月于武警海警总队医院就诊的老年腹股沟疝患者150例为研究对象,采用随机对照研究方法,根据随机数字表法将患者分为对照组(75例)和研究组(75例)。两组均择期行腹腔镜无张力疝修补术,对照组术后行超声引导下腹横肌平面阻滞,研究组术后行超声引导下腰方肌阻滞。比较患者术后48 h内视觉模拟评分法(VAS)评分和Ramsay评分变化,检测术后24 h和48 h血清肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、去甲肾上腺素(NE)和皮质醇(Cor)等炎症及应激因子水平变化,比较术后48 h内补救镇痛次数、镇痛药物不良反应及神经阻滞相关并发症发生情况。结果两组患者术后4 h、8 h、12 h、24 h和48 h时间点Ramsay评分差异均无统计学意义(均P>0.05);两组患者术后4 h和8 h时间点VAS评分差异均无统计学意义(均P>0.05),研究组患者术后12 h、24 h和48 h时间点的VAS评分[(1.36±0.57)分、(2.05±0.56)分、(1.79±0.55)分]均显著低于对照组[(1.92±0.59)分、(2.68±0.62)分、(2.36±0.59)分](t=6.65、7.31、5.86,均P<0.001);研究组术后24 h和48 h血清TNF-α、IL-6、NE和Cor水平[术后24 h:(63.89±4.65)ng/L、(156.59±8.62)ng/L、(97.02±6.95)g/L,(36.95±3.26)g/L,术后48 h:(49.66±3.74)ng/L、(131.45±7.73)ng/L、(74.63±5.91)g/L、(30.41±2.96)g/L]均显著低于对照组[术后24 h:(76.42±5.17)ng/L、(189.32±10.41)ng/L、(105.53±7.83)g/L、(45.16±3.74)g/L,术后48 h:(58.15±3.94)ng/L、(162.74±8.49)ng/L、(89.51±6.37)g/L、(36.92±3.31)g/L](t=10.49~26.38,均P<0.001);研究组术后48 h内实施补救镇痛的患者比例[8.00%(6/75)]显著低于对照组[25.33%(19/75)](χ^(2)=8.11,P=0.004);研究组术后48 h内镇痛药物不良反应总体发生率[6.67%(3/75)]显著低于对照组[11.00%(11/75)](χ^(2)=4.61,P=0.032)。结论超声引导下腰方肌阻滞较腹横肌平面阻滞更有助于缓解老年腹股沟疝患者术后疼痛,抑制炎症及应激反应,减少镇痛药物用量,降低药物不良反应发生率。

Objective To investigate the analgesic effect of ultrasound-guided transversus abdominis plane block versus ultrasound-guided quadratus lumborum block in older adult patients undergoing inguinal hernia repair surgery.Methods A total of 150 older adult patients who underwent inguinal hernia repair surgery at the Marine Police Corps Hospital of Chinese People's Armed Police Force from April 2019 to May 2022 were included in this study.They were randomly divided into a control group(n=75)and a study group(n=75)using a random number table method.All patients underwent elective laparoscopic tension-free inguinal hernia repair surgery.Patients in the control group received ultrasound-guided transversus abdominis plane block after inguinal hernia repair surgery,while those in the study group received ultrasound-guided quadratus lumborum block.The changes in Visual Analog Scale(VAS)score and Ramsay score within 48 hours after surgery were compared between the two groups.Inflammatory factors and stress factors including serum tumor necrosis factor alpha,interleukin-6,norepinephrine,and cortisol,were measured at 24 and 48 hours after surgery.The use of analgesics,drug-related adverse reactions,and incidence of nerve block-related complications within 48 hours after surgery were also compared between the two groups.Results There was no significant difference in Ramsay score between the two groups at 4,8,12,24,and 48 hours after surgery(all P>0.05).There was no significant difference in VAS score between the two groups at 4 and 8 hours after surgery(both P>0.05).At 12,24,and 48 hours after surgery,the VAS score in the study group was(1.36±0.57)points,(2.05±0.56)points,and(1.79±0.55)points,respectively,which were significantly lower than(1.92±0.59)points,(2.68±0.62)points,and(2.36±0.59)points in the control group(t=6.65,7.31,5.86,all P<0.001).At 24 and 48 hours after surgery,serum tumor necrosis factor alpha,interleukin-6,norepinephrine,and cortisol levels in the study group[24 hours:(63.89±4.65)ng/L,(156.59±8.62)ng/L,(97.02±6.95)g/L,(36.95±3.26)g/L;48 hours:(49.66±3.74)ng/L,(131.45±7.73)ng/L,(74.63±5.91)g/L,(30.41±2.96)g/L]were significantly lower than those in the control group[24 hours:(76.42±5.17)ng/L,(189.32±10.41)ng/L,(105.53±7.83)g/L,(45.16±3.74)g/L;48 hours:(58.15±3.94)ng/L,(162.74±8.49)ng/L,(89.51±6.37)g/L,(36.92±3.31)g/L,t=10.49-26.38,all P<0.001].The proportion of patients who received analgesics within 48 hours after surgery in the study group was 8.00%(6/75),which was significantly lower than 25.33%(19/75)in the control group(χ^(2)=8.11,P=0.004).The overall incidence of drug-related adverse reactions within 48 hours after surgery in the study group[6.67%(3/75)]was significantly lower than that in the control group[11%(11/75),χ^(2)=4.61,P=0.032].Conclusion Compared with ultrasound-guided transversus abdominis plane block,ultrasound-guided quadratus lumborum block better helps alleviate postoperative pain in older adult patients undergoing inguinal hernia repair surgery,inhibits inflammation and stress reactions,reduces the dosage of analgesic drugs,and decreases the incidence of adverse drug reactions.