超声引导下腰方肌阻滞对异位妊娠急救患者术中血流动力学和阿片类药物用量的影响

Effect of ultrasound-guided quadratus lumborum block on intraoperative hemodynamics and opioid dosage in emergency patients with ectopic pregnancy

目的观察超声引导下腰方肌阻滞(QLB)对异位妊娠急救患者术中血流动力学及阿片类药物用量的影响。方法选择2021年1月至2024年2月廊坊市人民医院收治的70例异位妊娠行腹腔镜手术患者作为研究对象。按麻醉方法不同将患者分为对照组和研究组,每组35例。对照组给予常规全麻方案,研究组在其基础上采用超声引导下QLB。观察两组患者术中镇静效果、不同时间(入院、入室、插管、切皮、拔管、出室时)血流动力学、术后疼痛、不良反应发生率等相关指标及阿片类药物使用情况。结果两组镇静起效时间、补救镇静率、术中体动发生率、各时间点改良警觉/镇静评分(MOAA/S)及入院、入室和插管时血流动力学水平比较差异均无统计学意义;研究组切皮、拔管、出室时平均动脉压(MAP)、收缩压(SBP)、心率(HR)均明显低于对照组〔切皮时:MAP(mmHg,1 mmHg≈0.133 kPa)为85.24±4.59比96.95±4.68,SBP(mmHg)为92.24±4.85比99.49±5.13,HR(次/min)为85.33±2.96比94.51±2.92;拔管时:MAP(mmHg)为94.84±5.02比102.05±5.13,SBP(mmHg)为96.48±4.72比105.03±5.07,HR(次/min)为95.51±4.95比102.49±5.87;出室时:MAP(mmHg)为86.14±4.99比93.71±5.25,SBP(mmHg)为96.48±4.69比104.37±5.02,HR(次/min)为84.05±4.57比90.51±4.86,均P<0.05〕,脉搏血氧饱和度(SpO2)明显高于对照组(切皮时:0.9885±0.0122比0.9654±0.0123,拔管时:0.9747±0.0124比0.9632±0.0121,出室时:0.9811±0.0124比0.9703±0.0123,均P<0.05);研究组术后3、6、12、24 h静息疼痛数字评价量表(NRS)评分及活动NRS评分均低于对照组,随时间延长,两组静息NRS和活动NRS均逐渐升高,术后24 h达到峰值,研究组静息NRS和活动NRS均明显低于对照组〔静息NRS评分(分):3.86±0.82比4.53±1.04,活动NRS评分(分):4.26±1.05比4.85±1.13,均P<0.05〕;术后2 d,研究组不良反应发生率明显低于对照组〔11.43%(4/35)比34.29%(12/35),P<0.05〕;研究组术后24 h和48 h舒芬太尼用量、48 h镇痛泵按压次数、补救镇痛例数均低于对照组〔24 h舒芬太尼用量(μg):23.28±4.02比36.14±4.57,48 h舒芬太尼用量(μg):41.61±4.82比59.33±6.25,48 h镇痛泵按压次数(次):2.94±1.22比6.15±1.71,补救镇痛比例:8.57%(3/35)比28.57%(10/35),均P<0.05〕。结论超声引导下QLB能减少异位妊娠急救患者术中血流动力学波动,缓解患者术后疼痛并减少不良反应及阿片类药物使用量,有较好的效果。

Objective To study the effects of ultrasound-guided quadratus lumborum block(QLB)on intraoperative hemodynamics and opioid dosage in emergency patients with ectopic pregnancy.Methods A total of 70 patients with ectopic pregnancy undergoing laparoscopic surgery in Langfang People's Hospital from January 2021 to February 2024 were selected as subjects.According to the different anesthesia methods,the patients were divided into the control group and the study group,with 35 cases in each group.The control group was given general anesthesia,while the study group additionally added ultrasound-guided QLB.The intraoperative sedation effect,hemodynamics,postoperative pain,incidence of adverse reactions and opioid use at different times(admission,entry,intubation,skin incision,extubation,and discharge)were observed in the two groups.Results There were no statistically significant differences in the onset time of sedation,the rate of salvage sedation,the incidence of intraoperative body movements,the modified observer's assessment of alert/sedation(MOAA/S)at each time,and the hemodynamics at the time of admission,entry and intubation between the two groups.The mean arterial pressure(MAP),systolic blood pressure(SBP)and heart rate(HR)in the study group were significantly lower than those in the control group during skin incision,extubation and discharge[skin incision:MAP(mmHg,1 mmHg≈0.133 kPa)was 85.24±4.59 vs.96.95±4.68,SBP(mmHg)was 92.24±4.85 vs.99.49±5.13,HR(times/min)was 85.33±2.96 vs.94.51±2.92;extubation:MAP(mmHg)was 94.84±5.02 vs.102.05±5.13,SBP(mmHg)was 96.48±4.72 vs.105.03±5.07,HR(times/min)was 95.51±4.95 vs.102.49±5.87;discharge:MAP(mmHg)was 86.14±4.99 vs.93.71±5.25,SBP(mmHg)was 96.48±4.69 vs.104.37±5.02,HR(times/min)was 84.05±4.57 vs.90.51±4.86,all P<0.05]and pulse oxygen saturation(SpO2)was higher than those in the control group(skin incision:0.9885±0.0122 vs.0.9654±0.0123,extubation:0.9747±0.0124 vs.0.9632±0.0121,discharge:0.9811±0.0124 vs.0.9703±0.0123,all P<0.05).The resting numeric rating scale(NRS)scores and active NRS scores in the study group were lower than those in the control group at 3,6,12,and 24 hours after surgery,the random time was prolonged,the resting NRS and active NRS in the two groups gradually increased,reaching a peak at 24 hours after surgery,and the resting NRS and active NRS in the study group were significantly lower than those in the control group(resting NRS:3.86±0.82 vs.4.53±1.04,active NRS:4.26±1.05 vs.4.85±1.13,all P<0.05).The incidence of adverse reactions in the study group was lower than that in the control group[11.43%(4/35)vs.34.29%(12/35),P<0.05].The dosage of Sufentanil in 24 hours and 48 hours,the number of analgesic pump in 48 hours and the number of relief analgesia cases in the study group were lower than those in the control group[the dosage of Sufentanil in 24 hours(μg):23.28±4.02 vs.36.14±4.57,the dosage of Sufentanil in 48 hours(μg):41.61±4.82 vs.59.33±6.25,the number of analgesic pump in 48 hours(times):2.94±1.22 vs.6.15±1.71,the proportion of relief analgesia:8.57%(3/35)vs.28.57%(10/35),all P<0.05].Conclusion Ultrasound-guided QLB can reduce hemodynamic fluctuations,relieve postoperative pain,reduce adverse reactions and opioid use in emergency patients with ectopic pregnancy,demonstrating a positive impact.