| 摘要: |
| 目的 探讨超声引导腰方肌阻滞（quadratus lumborum block,QLB）与腹横肌平面阻滞（transversus abdominis plane block,TAP）对妇科肿瘤术后镇痛效果的影响。方法 选择2016年10月-2018年9月在重庆市公共卫生医疗救治中心择期行妇科开腹肿瘤手术患者60例，年龄23-53岁，体质量52-71kg，ASA分级Ⅰ-Ⅱ级，采用随机数字表随机分为腰方肌阻滞组（QLB组）和腹横筋膜阻滞组(TAP组)各30例。QLB组患者于全麻诱导后手术前行超声引导下双侧QLB，每侧给予0.25%罗哌卡因20ml，TAP组于全麻手术后在双侧肋缘下行超声引导下双侧TAP。记录两组术后2,4,8,12,24,36,48h静息和24,36,48h运动时的VAS评分；观察两组患者切皮前即刻、切皮后5min的SBP DBP和HR，得到其差值；记录术后不同时间段舒芬太尼用量、术后满意、补救镇痛率、恶心呕吐发生情况。结果 QLB患者在术后4h、8h、12h、24h、36h时的静息状态下VAS评分和术后24h、36h、48h时的运动状态下VAS评分均低于TAP组患者，差异具有统计学意义（P＜0.05）；切皮前即刻、切皮后5min，QLB组的DBP、HR的差值均明显小于TAP组，差异具有统计学意义（P＜0.05）；QLB组患者在0-6h、6-12h、12-24h、24-36h的舒芬太尼用量和舒芬太尼总消耗量均少于TAP组（P＜0.05）；QLB组患者术后满意度明显高于TAP组（P＜0.05）。与TAP组相比，QLB组患者使用静脉镇痛泵进行补救性镇痛的比例和恶心呕吐的发生率明显降低（P＜0.05）。结论 与TAP相比，妇科肿瘤患者术后实施超声引导QLB镇痛效果佳，能显著缓解术后疼痛，减少阿片类药物使用，提高患者满意度及舒适度。 |
| 关键词: 超声引导 腰方肌阻滞 腹横肌平面阻滞 妇科肿瘤术 镇痛 |
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| Effect of ultrasound-guided quadratus lumborum block and transversus abdominis plane block on postoperative analgesia in patients undergoing gynecologic tumors |
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| Abstract: |
| Objective To investigate the effect of ultrasound-guided quadratus lumborum block (QLB) and transversus abdominis plane block(TAP)on postoperative analgesia of gynecologic tumors. Methods There are 60 patients in this study who underwent gynecologic oncology surgery in our hospital from July 2016 to September 2018, aged 23-53 years old, body mass 52-71kg, ASAI-II. They were randomly divided into quadratus lumborum block (QLB group) and the transversus abdominis plane block group (TAP group) each 30 cases. Patients in the QLB group underwent ultrasound-guided bilateral QLB before general anesthesia induction, and each side received 0.25% ropivacaine 20ml. Ultrasound-guided bilateral transversus abdominis plane block in the TAP group after bilateral anesthesia. The values of systolic blood pressure (SBP),diastolic blood pressure (DBP ),heart rate(HR) immediately before and 5min after cutting were oberserved and recorded. The patient's the visual analogue scores(VAS) of 2, 4, 8, 12, 24, 36, 48h after surgery and 24, 36, 48h during exercise, Sufentanil dosage at different time points after surgery, postoperative satisfaction, remedial analgesia, nausea and vomiting were recorded in the two group. Result The VAS scores of the patients with QLB at 4h, 8h, 12h, 24h, and 36h after surgery were lower than those of the TAP group at 24h, 36h, and 48h after surgery. The difference was statistically significant ( P<0.05). The difference of DBP and HR in QLB group was significantly lower than that in TAP group immediately after incision and 5min after incision. The difference was statistically significant (P<0.05). The doses of sufentanil and the total amount of sufentanil in the QLB group were lower than those in the TAP group at 0-6h, 6-12h, 12-24h, 24-36h (P<0.05). The postoperative satisfaction of patients in the QLB group was significantly higher than that in the TAP group (P<0.05). Compared with TAP group, the proportion of patients with remedial analgesia and the incidence of nausea and vomiting in patients with QLB group was significantly lower (P<0.05).Conclusion Compared with TAP ,Ultrasound-guided QLB analgesia after gynecologic tumor surgery can significantly relieve postoperative pain, reduce the use of opioids, and improve patient satisfaction and comfort. |
| Key words: Ultrasound guidance Quadratus lumborum block Transversus abdominis plane block Gynecologic oncology Analgesia |