弓状韧带上腰方肌阻滞对全麻机器人辅助腹腔镜前列腺癌根治术患者术后肺功能的影响

Effect of anterior quadratus lumborum block at the lateral supra-arcuate ligament on postoperative pulmonary function in patients undergoing robot-assisted laparoscopic radical prostatectomy under general anesthesia

目的评价弓状韧带上腰方肌阻滞对全麻机器人辅助腹腔镜前列腺癌根治术患者术后肺功能的影响。方法择期全麻下行机器人辅助腹腔镜前列腺癌根治术患者72例,年龄50~80岁,ASA分级Ⅰ~Ⅲ级,BMI 18.5~27.9 kg/m^(2),采用随机数字表法分为2组(n=36):对照组和观察组。观察组在全麻诱导后在超声引导下行双侧弓状韧带上腰方肌阻滞,每侧给予0.375%罗哌卡因20 ml,对照组仅行单纯全凭静脉麻醉。术毕采用PCIA至术后48 h,静态VAS评分≥4分时,静脉注射地佐辛补救镇痛。分别于术前1 d和术后1~7 d时检测肺功能,记录用力肺活量(FVC)、1 s用力呼气容量(FEV1)、最大呼气中期流量(FEF 25%-75%)及其恢复至80%预计值的时间。分别于术前1 d和术后1~3 d时行动脉血气分析,记录SpO_(2)、PaO_(2)及PaCO_(2)。记录术中瑞芬太尼用量、镇痛泵有效按压次数及补救镇痛例数;记录术后7 d内肺部并发症发生情况和30 d内再次住院情况;记录术后肛门排气时间、住院时间及术后3 d内不良反应(头晕、恶心、呕吐)发生情况。结果与对照组比较,观察组术后FVC、FEV1和FEF 25%-75%升高,FVC、FEV1和FEF 25%-75%恢复至80%预计值的时间缩短,术后SpO_(2)和PaO_(2)升高,PaCO_(2)降低,术中瑞芬太尼用量、镇痛泵有效按压次数及补救镇痛例数减少,术后肛门排气时间和住院时间缩短,不良反应和肺部并发症发生率降低(P<0.05)。结论弓状韧带上腰方肌阻滞用于全麻机器人辅助腹腔镜前列腺癌根治术,可改善术后肺功能,减少不良反应,促进早期恢复。

Objective To evaluate the effect of anterior quadratus lumborum block at the lateral supra-arcuate ligament on the postoperative pulmonary function in patients undergoing robot-assisted laparoscopic radical prostatectomy under general anesthesia.Methods Seventy-two American Society of Anesthesiologists Physical Status classificationⅠ-Ⅲpatients,aged 50-80 yr,with body mass index of 18.5-27.9 kg/m^(2),scheduled for elective robot-assisted laparoscopic radical prostatectomy under general anesthesia,were divided into 2 groups(n=36 each)using a random number table method:control group and observation group.After induction of general anesthesia,observation group underwent anterior quadratus lumborum block at the lateral supra-arcuate ligament under ultrasound guidance,with 20 ml of 0.375%ropivacaine administered on each side.Control group only received total intravenous anesthesia.Postoperative analgesia was provided by patient-controlled intravenous analgesia until 48 h after operation,and intravenous dezocine was administered as rescue analgesic when the visual analogue scale score at rest≥4.Pulmonary function was assessed at 1 day before surgery and 1-7 days after surgery.Forced vital capacity(FVC),forced expiratory volume in 1 s(FEV1),maximal mid-expiratory flow rate(FEF 25%-75%),and time to recovery of 80%predicted pulmonary function were recorded.Arterial blood gas analysis was performed at 1 day before surgery and 1-3 days after surgery,and SpO_(2),PaO_(2) and PaCO_(2) were recorded.The consumption of intraoperative remifentanil,effective pressing times of patient-controlled analgesia,and the number of patients required rescue analgesia were recorded.Postoperative pulmonary complications within 7 days after operation and re-hospitalization within 30 days were recorded.The time to first flatus,postoperative length of hospital stay and occurrence of adverse reactions(dizziness,nausea,vomiting)within 3 days after surgery were also recorded.Results Compared with control group,FVC,FEV1 and FEF 25%-75%were significantly increased postoperatively,the time to recovery of 80%FVC,FEV1 and FEF 25%-75%was shortened,postoperative SpO_(2) and PaO_(2) were increased,postoperative PaCO_(2) was decreased,the consumption of intraoperative remifentanil,effective pressing times of patient-controlled analgesia,and the number of patients required rescue analgesia were reduced,the postoperative time to first flatus and length of hospital stay were shortened,and the incidence of adverse reactions and pulmonary complications was decreased(P<0.05).Conclusions Anterior quadratus lumborum block at the lateral supra-arcuate ligament can improve postoperative pulmonary function,reduce adverse reactions,and promote early recovery for the patients undergoing robot-assisted laparoscopic radical prostatectomy under general anesthesia.