超声引导下不同入路腰方肌阻滞联合羟考酮在腹腔镜结直肠癌根治术后镇痛效果中的对比研究

Comparative Study on the Analgesic Effect of Ultrasound-Guided Quadratus Lumborum Block Combined with Oxycodone in Different Approaches after Laparoscopic Colorectal-Carcinoma Surgey

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.