胸腔镜肺叶切除术中弓状韧带上腰方肌前侧阻滞的应用价值

Application value of block on the anterior side of the muscle of the arcuate ligament in thoracoscopic lobectomy

目的探究胸腔镜肺叶切除术中弓状韧带上腰方肌前侧阻滞的应用价值。方法前瞻性选取2020年3月至2023年7月在安徽中医药大学第一附属医院接受胸腔镜肺叶切除术治疗的患者80例作为研究对象,按照随机数字表法将患者进行分组:对照组40例和研究组40例。对照组患者接受常规静脉镇痛,研究组患者加用弓状韧带上腰方肌前侧阻滞。比较两组患者的临床指标(手术时间、单肺通气时间、出血量、胸腔引流管拔除时间、镇痛补救次数),术后24 h的40项恢复质量量表(QoR-40)评分,进入麻醉恢复室时、进入后30 min及术后12 h、24 h、48 h时的疼痛[视觉模拟评分法(VAS)评分]情况,镇痛满意度及不良反应发生情况。结果两组间手术时间、单肺通气时间、出血量及胸腔引流管拔除时间比较,差异均无统计学意义(P>0.05),研究组患者的镇痛追加次数为(1.23±0.34)次,低于对照组[(3.56±0.67)次],差异有统计学意义(P<0.05)。两组术后24 h QoR-40评分在情绪、社交、行为方面评分比较,差异均无统计学意义(P>0.05),研究组舒适度、疼痛及总分分别为(48.98±2.13)、(28.16±1.79)、(165.84±3.03)分,均高于对照组[(46.11±2.02)、(25.65±1.23)、(161.19±4.11)分],差异均有统计学意义(P<0.05)。研究组在进入麻醉恢复室时、进入后30 min及术后12 h、24 h、48 h时的VAS评分分别为(1.44±0.89)、(1.89±0.56)、(2.65±0.98)、(2.23±0.79)、(1.55±0.89)分,均低于对照组[(1.88±0.98)、(2.31±1.13)、(4.22±1.29)、(3.79±0.89)、(1.99±1.02)分],差异均有统计学意义(P<0.05)。研究组患者的镇痛满意度为(3.29±0.61)分,高于对照组[(2.56±0.56)分],恶心、呕吐、尿潴留的发生率分别为7.50%、5.00%、2.50%,均低于对照组(25.00%、20.00%、15.00%),差异均有统计学意义(P<0.05),但组间发生呼吸抑制的情况比较,差异无统计学意义(P>0.05)。结论胸腔镜肺叶切除术中采用弓状韧带上腰方肌前侧阻滞可以提供更好的术后镇痛,提高患者的恢复速度,且安全性较高,具有重要的临床应用价值。

Objective To investigate the application value of lateral block of quadrate lumbosi muscle above arcuate ligament in unilateral thoracoscopic lobectomy.Methods Eighty patients who underwent thoracoscopic lobectomy at the First Affiliated Hospital of Anhui University of Chinese Medicine from March 2020 to July 2023 were prospectively selected as research subjects.Patients were divided into the control group 40 patients and the study group 40 patients according to the random number table method.Patients in the control group received conventional intravenous analgesia,and patients in the study group received anterior block of superior lumbar muscle.The clinical indicators of two groups of patients(surgical time,single lung ventilation time,bleeding volume,time for removal of thoracic drainage tube,number of times for pain relief),the 24 h quality of recovery-40 questionnaire(QoR-40)scale score,pain[visual analogue scale(VAS)score]situation at the time of entry into the anesthesia recovery room,30 minutes after entry,12 hours,24 hours,and 48 hours after surgery,analgesic satisfaction and adverse reactions were compared between two groups.Results There were no statistically significant differences between the groups in operation time,single lung ventilation time,bleeding volume and chest drain removal time(P>0.05),and the number of analgesic additions in the study group was(1.23±0.34)times,which was lower than that in the control group(3.56±0.67)times,the difference was statistically significant(P<0.05).There were no statistically significant differences between the two groups in mood,social,and behavior on the 24 h QoR-40 scale after surgery(P>0.05),and comfort,pain and total score were(48.98±2.13),(28.16±2.79),(165.84±3.03)points in the study group,respectively,which were higher than those in the control group[(46.11±2.02),(25.65±1.23),(161.19±4.11)points],the differences were statistically significant(P<0.05).The VAS scores of the study group were(1.44±0.89),(1.89±0.56),(2.65±0.98),(2.23±0.79),and(1.55±0.89)points at the time of entry into the anesthesia recovery room,30 minutes after entry,12 hours,24 hours,and 48 hours after surgery,respectively,which were lower than those of the control group[(1.88±0.98),(2.31±1.13),(4.22±1.29),(3.79±0.89),and(1.99±1.02)points],and the differences were statistically significant(P<0.05).The pain relief satisfaction of patients in the study group was(3.29±0.61)points,which was higher than that of the control group[(2.56±0.56)points],and the incidence of nausea,vomiting,and urinary retention were 7.50%,5.00%,and 2.50%,respectively,which were lower than those of the control group(25.00%,20.00%,and 15.00%),and the differences were statistically significant(P<0.05);but there was no statistically significant difference in the occurrence of respiratory depression between the two groups(P>0.05).Conclusion In the unilateral thoracoscopic lobectomy,the use of anterior block of the quadrate lumbosus superior arcuate ligament can provide better postoperative pain management,improve the quality of recovery of patients,and have high safety,so it has important clinical application value.