超声引导下腰方肌阻滞与腹横肌平面阻滞对子宫切除术后镇痛效果和安全性对比分析

Comparative analysis of the efficacy and safety of ultrasoundguided quadratus lumborum block and transversus abdominis plane block for postoperative analgesia after hysterectomy

目的探讨在超声引导下腰方肌阻滞与腹横肌平面阻滞对子宫切除术患者术后的镇痛效果及分析比较两者的安全性。方法选取樟树市人民医院2021年5月-2022年2月择期行腹腔镜下子宫切除术患者62名,采用随机数字表法分为Q组(n=31)和T组(n=31),两组分别在超声引导下行双侧外侧弓状韧带上腰方肌前侧阻滞和侧入路双侧腹横肌平面阻滞。术毕,两组使用药物相同的自控静脉镇痛泵(PCIA)。对比两组补救性镇痛次数、首次按压镇痛泵时间、长海痛尺评分、麻醉术后各方面恢复评定量表评分(QOR-40)、首次下床时间、首次肛门排气时间、术后不良反应发生率之间的差异。结果相较于T组,Q组首次使用镇痛泵的时间较晚,补救性镇痛次数较少,首次下床时间和首次肛门排气时间更早,QOR-40评分显著较高,不良反应发生率也较低,差异有统计学意义(P<0.05)。长海痛尺评分不同时间段、组别间方差分析结果,测量时间段和组别之间交互作用结果有统计学意义(P<0.05)。结论超声引导下的腰方肌阻滞术在镇痛效果和安全性方面优于腹横肌平面阻滞,可有效缓解患者术后疼痛感受、降低不良反应发生率,减轻患者术后康复的负担。

Objective To explore the analgesic effect of ultrasound-guided low back quadrate block and transversal plane block on postoperative hysterectomy patients and analyze and compare their safety.Methods A total of 62 patients who underwent elective laparoscopic hysterectomy in People's Hospital of Zhangshu City from May 2021 to February 2022 were selected and divided into two groups by random number table method Q group(n=31)and T group(n=31).The two groups were respectively suhjected to bilateral lateral arcuate ligamentum anterior block and bilateral transverse abdominal plane block by lateral approach under ultrasound guidance.After surgery,both groups were treated with the same drug controlled intravenous analgesia pump(PCIA).The number of remedial analgesia,the first time to press the analgesic pump,the score of Changhai pain scale,the score of all aspects of recovery rating scale(QOR-40),the first time to get out of bed,the first time to exhaust gas,and the incidence of postoperative adverse reactions were compared between the two groups.Results Compared with the T group,the first use of analgesic pump in the Q group was later,the number of remedial analgesia was less,the first time to get out of bed and the first exhaust time were earlier,the QOR-40 score was significantly higher,and the incidence of adverse reactions was lower,the difference was statistically significant(P<0.05).The results of ANOVA for different time periods and groups showed that the interaction between the measurement period and groups had statistical significance(P<0.05).Conclusion Ultrasound-guided quadrate lumbar block is superior to transversal plane block in analgesia and safety,which can effectively relieve postoperative pain,reduce the incidence of adverse reactions,and reduce the burden of postoperative rehabilitation.