超声引导下腰方肌阻滞用于肾部分切除术患者术后镇痛的影响

Effects of ultrasound-guided quadratus lumborum block on postoperative analgesia in patients undergoing partial nephrectomy

目的观察全麻联合超声引导下腰方肌阻滞在肾部分切除术患者术后镇痛的效果,以期为临床应用提供更多的证据。方法收集从2017年9月—2018年9月之间择期在河南省人民医院行肾部分切除术的患者资料,将患者随机分为单纯全麻组(C组)和全麻联合腰方肌阻滞组(T组),共纳入患者70例,每组35例。所有患者均使用静脉镇痛泵(PCIA),T组患者于全麻诱导前超声引导下行患侧腰方肌阻滞,主要观察指标包括切皮前及切皮后2 min患者血压、心率变化(ΔSBP、ΔDBP、ΔMAP和ΔHR),术后1、6、12、24 h静息及活动模拟视觉评分(VAS),镇痛泵首次按压时间、总按压次数、有效按压次数、术后进行补救镇痛的例数。比较两组患者观察指标之间是否存在差异。结果 T组患者切皮前及切皮后2 min血压、心率变化均较C组小(P<0.05),T组患者术后1、6、12 h静息及活动VAS评分均明显低于C组(P<0.05),术后24 h评分无统计学差异;与C组相比,T组患者首次按压镇痛泵时间要晚(P<0.05),48 h镇痛泵有效按压次数、总按压次数明显较少(P<0.05),镇痛泵有效按压比例更高(P<0.05),使用舒芬太尼进行补救镇痛比例更低(P=0.013)。结论在患者静脉自控镇痛的基础上复合单次腰方肌阻滞可以有效缓解腔镜下肾部分切除患者的术后疼痛,减少术后阿片类药物的用量。

Objective To investigate the effects of ultrasound-guided quadratus lumborum block on postoperative analgesia in patients undergoing partial nephrectomy.Methods Totally 70 patients undergoing partial nephrectomy in Henan Provincial People’s Hospital between September 2017 and September 2018 were enrolled in this study.They were randomly assigned to receive general anesthesia(n=35,group C)and general anesthesia with QLB(n=35,group T).All patients used patient-controlled intravenous analgesia(PCIA).The values of blood pressure and heart rate befor and after 2 min after cutting were recorded.The visual analogue scale(VAS)for pain at rest and on movement after surgery in 1 h,6 h,12 h and 24 h were valued.48 h after surgery,the first time pressing the analgesic pump button,the total and effective pressing frequency,the times of remedial analgesia were all recorded.Results The changes of BP and HR befor and after incision in group T were significantly lower than those in group C(P<0.05).The 1 h、6 h and 12 h VAS after surgry of group T were lower than those in group C(P<0.05)while for 24 h,the scores were similar.Compared with group C,the first time pressing the analgesic pump button in group T were later(P<0.05).The total effective pressing frequency(P<0.05),the times of remedial analgesia(P=0.013)in group T were all less than those in group C.Conclusion The QLB can provided satisfactory analgesia in combination with PCIA and reduce the usage of opioid.