摘要
目的:对比超声引导下不同入路腰方肌阻滞(QLB)联合羟考酮在腹腔镜结直肠癌根治术(LCS)后的镇痛效果。方法:按照随机数字表法将我院2021年4月~2023年3月期间148例行LCS的患者分为A组、B组和C组,例数分别为49例、49例和50例。A组接受羟考酮,B组接受后路QLB联合羟考酮,C组接受外侧弓状韧带上腰方肌前侧阻滞(QLB-LSAL)联合羟考酮。对比三组术后48 h补救镇痛例数、自控静脉镇痛(PICA)有效按压次数、静息时和咳嗽时的疼痛视觉模拟(VAS)评分、苏醒质量、应激反应指标[皮质醇(Cor)、肾上腺素(E)、去甲肾上腺素(NE)]和不良反应发生率。结果:A组、B组、C组的术后48 h补救镇痛例数依次减少(P<0.05)。A组、B组、C组的PICA有效按压次数依次减少(P<0.05)。A组、B组、C组苏醒时间、首次下床时间、术后住院天数依次缩短(P<0.05)。术后12 h、术后24 h、术后48 h,A组、B组、C组的静息时和咳嗽时的VAS评分依次下降(P<0.05)。术后1 d,A组、B组、C组Cor、E、NE依次下降(P<0.05)。三组不良反应发生率组间对比未见差异(P>0.05)。结论:超声引导下QLB-LSAL联合羟考酮用于LCS后镇痛效果明显,可减轻机体的应激反应,促进患者术后恢复。
Objective:To compare the analgesic effect of ultrasound-guided quadratus lumborum block(QLB)combined with oxycodone in different approaches after laparoscopic colorectal-carcinoma surgey(LCS).Methods:According to the random number table method,148 patients who underwent LCS in our hospital from April 2021 to March 2023 were divided into group A,group B and group C,with 49 cases,49 cases and 50 cases respectively.Group A received oxycodone,group B received posterior QLB combine with oxycodone,and group C received anterior quadratus lumborum block on lateral arcuate ligament(QLB-LSAL)combine with oxycodone.The number of remedial analgesia cases at 48 h after operation,the effective pressing times of patient-controlled intravenous analgesia(PICA),the visual analogue scale(VAS)scores at rest and cough,the quality of awakening,the stress response indexes[cortisol(Cor),epinephrine(E),norepinephrine(NE)]and the incidence of adverse reactions were compared among three groups.Results:The number of remedial analgesia cases in group A,group B and group C decreased in turn at 48 h after operation(P<0.05).The effective pressing times of PICA in group A,group B and group C decreased in turn(P<0.05).The recovery time,the first time to get out of bed,and the hospital stay after operation in group A,group B,and group C were shortened in turn(P<0.05).The VAS scores in group A,group B and group C at rest and cough decreased in turn at 12 h,24 h and 48 h after operation(P<0.05).1 d after operation,Cor,E and NE in group A,group B and group C decreased in turn(P<0.05).There was no difference in the incidence of adverse reactions among three groups(P>0.05).Conclusion:Ultrasound-guided QLB-LSAL combined with oxycodone has a significant analgesic effect after LCS,which can reduce the body's stress response and promote recovery after operation.
作者
陈霞
郑立东
詹利
叶奎
王金权
勾宝晶
CHEN Xia;ZHENG Li-dong;ZHAN Li;YE Kui;WANG Jin-quan;GOU Bao-jing(Department of Anesthesiology,Lu'an Hospital of Anhui Medical University,Lu'an,Anhui,237000,China;Department of Anesthesiology,Pediatric Hospital Affiliated to Fudan University,Shanghai,201102,China)
出处
《现代生物医学进展》
CAS
2024年第16期3061-3065,共5页
Progress in Modern Biomedicine
基金
2021年安徽医科大学科研平台基地建设提升计划项目(2021xkjT041)
安徽高校自然科学研究项目(KJ2016A329)。
关键词
不同入路
腰方肌阻滞
羟考酮
腹腔镜结直肠癌根治术
镇痛效果
Different approaches
Quadratus lumborum block
Oxycodone
Laparoscopic colorectal-carcinoma surgey,Analgesic effect