弓状韧带上腰方肌前侧阻滞联合全身麻醉在腹腔镜胆囊切除术中的应用效果

Application effects of anterior quadratus lumborum block at the lateral supra-arcuate ligament combined with general anesthesia in laparoscopic cholecystectomy

目的:观察弓状韧带上腰方肌前侧阻滞(SA-AQLB)联合全身麻醉在腹腔镜胆囊切除术(LC)中的应用效果。方法:选取2020年4月至2022年1月该院收治的78例LC患者进行前瞻性研究,按照随机数字表法分为研究组与对照组各39例。对照组给予全身麻醉,研究组在对照组基础上联合SA-AQLB,比较两组气管拔管时间、术后48 h补救镇痛率、术后不同时间(术后2、6、12、24、48 h)视觉模拟评分法(VAS)评分、术后恢复情况(苏醒时间、术后首次排气时间、术后首次下床时间、住院时间)、应激反应指标(随机血糖、血清皮质醇、血清肾上腺素)水平和不良反应发生率。结果:研究组术后48 h补救镇痛率低于对照组,气管拔管时间、苏醒时间、术后首次排气时间、术后首次下床时间、住院时间短于对照组,差异均有统计学意义(P<0.05);术后2、6、12、24、48 h,研究组VAS评分低于对照组,差异均有统计学意义(P<0.05);术后1、3 d,两组随机血糖、血清皮质醇、血清肾上腺素水平高于术前,但研究组低于对照组,差异均有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:SA-AQLB联合全身麻醉应用于LC患者可降低VAS评分、术后48 h补救镇痛率、应激反应指标水平,缩短其气管拔管时间、苏醒时间、术后首次排气时间、术后首次下床时间、住院时间,效果优于单纯全身麻醉。

Objective:To observe application effect of anterior quadratus lumborum block at the lateral supra-arcuate ligament(SA-AQLB)combined with general anesthesia in laparoscopic cholecystectomy(LC).Methods:A prospective study was conducted on 78 patients with LC admitted to the hospital from April 2020 to January 2022.According to the random number table method,they were divided into study group and control group,39 cases in each group.The control group was given general anesthesia,while the study group was combined with SA-AQLB on the basis of that of the control group.The tracheal extubation time,the remedial analgesia rate 48h after the surgery,the visual analogue scale(VAS)score at different time after the surgery(2,6,12,24,48 h after the surgery),the postoperative recovery(recovery time,first exhaust time,first out-of-bed time after,hospitalization time),the stress response index(random blood glucose,serum cortisol,serum epinephrine)levels,and the incidence of adverse reactions were compared between the two groups.Results:The remedial analgesia rate 48 h after the surgery in the study group was lower than that in the control group;the tracheal extubation time,the recovery time,thefirst exhaust time,thefirst out-of-bed time and the hospitalization time were shorter than those in the control group;and the differences were statistically significant(P<0.05).2,6,12,24 and 48 h after the surgery,the VAS scores of the study group were lower than those of the control group,and the differences were statistically significant(P<0.05).1 and 3 days after the surgery,the levels of random blood glucose,serum cortisol and serum adrenaline in the two groups were higher than those before operation,but those in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).However,there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions:SA-AQLB combined with general anesthesia in the LC patients can reduce the VAS scores,the remedial analgesia rate 48h after the surgery,the levels of stress response indexes,and shorten the tracheal extubation time,the recovery time,thefirst exhaust time,thefirst out-of-bed time and the hospitalization time.Moreover,it is superior to single general anesthesia.