超声引导下经弓状韧带上腰方肌阻滞在腹腔镜全子宫切除术患者中的应用

Application of lumbar square muscle block with ultrasound guidance in patients with laparoscopic total hysterectomy under ultrasound

目的观察超声引导下经弓状韧带上腰方肌阻滞对腹腔镜全子宫切除术患者整体获益水平的影响,以期为临床有关患者的阻滞方式提供科学参考意见。方法采用随机数表法将绵阳四○四医院2020年1月—2022年1月期间收治的98例开展腹腔镜全子宫切除术的患者分为对照组与研究组,每组各49例,对照组采取超声引导下经前路腰方肌阻滞,研究组采取超声引导下经弓状韧带上腰方肌阻滞,对比两组麻醉相关情况、疼痛情况(静息与活动时(咳嗽))、麻醉用药情况、术后恢复情况及不良反应与阻滞并发症。结果与对照组相比,研究组阻滞奏效时间块、阻滞后不同时点阻滞平面数量均较多(P<0.05),两组阻滞操作时长对比差异统无计学意义(P>0.05);静息时与活动时两种状态下,研究组疼痛评分较低(P<0.05);两组丙泊酚用量对比差异统无计学意义(P>0.05),研究组瑞芬太尼用量少(P<0.05);研究组术后下床活动、初次肛门排气、首次进食及住院时间均短于对照组(P<0.05);两组不良反应与阻滞并发症发生率对比差异统无计学意义(P>0.05)。结论超声引导下经弓状韧带上腰方肌阻滞应用于腹腔镜全子宫切除术患者,阻滞奏效块、短时间内阻滞平面数量多、利于缓解患者术后疼痛,加速术后恢复,且安全可靠。

Objective To observe the effect of lumbar muscle block under ultrasound guidance on the overall benefit level of patients with laparoscopic total hysterectomy under ultrasound,in order to provide scientific reference opinions for the blocking method of relevant patients.Methods The 98 patients who underwent laparoscopic total hysterectomy admitted to our hospital from January 2020 to January 2022 were divided into the control group and the research group,49 cases each.The control group adopted anterior lumbar muscle block,and the study group adopted ultrasound-guided transgillary ligament lumbar muscle block to compare the anesthesia-related conditions,pain(resting and activity(coughing)),anesthesia drug use,postoperative recovery,adverse reactions and block complications.Results Compared with the control group,there were more blocking time blocks and blocking planes at different points after blocking in the study group(P<0.05),and the block operation time between the two groups(P>0.05).In both states of rest and activity,the pain score in the study group was lower than that in the control group(P<0.05).The dosage of propofol in the two groups,(P>0.05).The dosage of remifentanil in the research group was less than that in the control group(P<0.05).The postoperative sex activity,initial anal exhaust,and the first eating time of the research group were all earlier than that of the control group,and the hospitalization time was shorter than that of the control group(P<0.05).Comparison of the occurrence of adverse reactions and block complications in the two groups(P>0.05).Conclusion Patients with laparoscopic total hysterectomy adopt ultrasound-guided lumbar lateral muscle blocking through arch ligament,which blocks and a large number of blocking planes in a short period of time are conducive to alleviating the patient's postoperative pain,promoting comfort,accelerating postoperative recovery,and being safe and reliable.