超声引导腰方肌阻滞与腹横肌平面阻滞在全腹式子宫切除术后的镇痛效果比较

Analgesic effect of ultrasound-guided quadratus lumborum block versus transversus abdominis plane block after total abdominal hyste-rectomy

目的 比较超声引导腰方肌阻滞和腹横肌平面阻滞在全腹式子宫切除术后的镇痛效果。方法 选取2021年7月—2023年7月本院收治的行全腹式子宫切除术的96例病人。按麻醉方式分为超声引导下腰方肌阻滞麻醉组(Q组)和超声引导下腹横肌平面阻滞麻醉组(T组),每组48例病人。比较两组术后视觉模拟评分法(VAS)评分,疼痛介质P物质(SP)、前列腺素E2(PGE2)、β-内啡肽(β-EP)水平及肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、白细胞介素10(IL-10)、去甲肾上腺素(NE)、血管紧张素Ⅱ(AngⅡ)、皮质醇(Cor)水平,不良反应与并发症发生情况。结果 Q组术后48 h补救镇痛占比、术后48 h舒芬太尼用量、术后48 h镇痛泵按压次数、首次肛门排气时间、下床活动时间、术后住院时间均低于T组(χ^(2)=10.889,t=7.438~25.212,P<0.05)。两组术后8、12、24 h静息和咳嗽时VAS评分与术后4 h相比均降低(P<0.05);Q组术后12、24 h静息和咳嗽时VAS评分均低于T组(F=2.287~5.602,P<0.05)。两组术后24 h的SP、β-EP、PGE2与术后4 h比较均升高(t=14.828~28.818,P<0.05);Q组术后4、24 h的SP、PGE2均低于T组,β-EP高于T组(t=6.551~8.838,P<0.05)。两组术后24 h的IL-6、IL-10、TNF-α、Cor、NE、AngⅡ与术后4 h比较均升高(t=7.970~66.636,P<0.05);Q组术后4、24 h的IL-6、IL-10、TNF-α、Cor、NE、AngⅡ均低于T组(t=4.799~40.097,P<0.05)。两组不良反应和并发症发生率差异无统计学意义(P>0.05)。结论 超声引导腰方肌阻滞和腹横肌平面阻滞对全腹式子宫切除术后镇痛均具有较好效果,前者镇痛效果更好,镇痛持续时间更长,可有效缓解术后炎性反应、应激水平,促进术后恢复。

Objective To investigate the analgesic effect of ultrasound-guided quadratus lumborum block versus transversus abdominis plane block after total abdominal hysterectomy.Methods A total of 96 patients who were admitted to our hospital and underwent total abdominal hysterectomy from July 2021 to July 2023 were enrolled,and according to the method for anesthesia,they were divided into ultrasound-guided quadratus lumborum block group(Q group)and ultrasound-guided transversus abdominis plane block group(T group),with 48 patients in each group.The two groups were compared in terms of postoperative Visual Analogue Scale(VAS)score,pain mediators(substance P(SP),prostaglandin E2(PGE2),andβ-endorphin(β-EP)),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-10(IL-10),norepinephrine(NE),angiotensinⅡ(AngⅡ),cortisol(Cor),adverse reactions,and complications.Results Compared with the T group,the Q group had a significantly lower proportion of patients receiving rescue analgesia at 48 h after surgery,a significantly lower amount of sufentanil used at 48 h after surgery,a significantly lower number of analgesia pump pressings at 48 h after surgery,and significantly shorter time to first flatus,time to ambulation,and length of postoperative hospital stay(χ^(2)=10.889,t=7.438-25.212,P<0.05).Both groups had a significant reduction in VAS score at resting and cough states from 4 h to 8,12,and 24 h after surgery(P<0.05),and compared with the T group,the Q group had a significantly lower VAS score at resting and cough states at 12 and 24 h after surgery(F=2.287-5.602,P<0.05).Both groups had significant increases in SP,β-EP,and PGE2 from 4 h to 24 h after surgery(t=14.828-28.818,P<0.05),and compared with the T group,the Q group had significantly lower levels of SP and PGE2 and a significantly higher level ofβ-EP at 4 and 24 h after surgery(t=6.551-8.838,P<0.05).Both groups had significant increases in the levels of IL-6,IL-10,TNF-α,Cor,NE,and AngⅡfrom 4 h to 24 h after surgery(t=7.970-66.636,P<0.05),and compared with the T group,the Q group had significantly lower levels of IL-6,IL-10,TNF-α,Cor,NE,and AngⅡat 4 and 24 h after surgery(t=4.799-40.097,P<0.05).There were no significant differences in the incidence rates of adverse reactions and complications between the two groups(P>0.05).Conclusion Both ultrasound-guided quadratus lumborum block and transversus abdominis plane block have a good analgesic effect after total abdominal hysterectomy,and ultrasound-guided quadratus lumborum block has a better analgesic effect anda longer duration of analgesia and can effectively alleviate postoperative inflammatory responseand stress levels and promote postoperative recovery.