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投稿时间：2024-05-21 网络发布日期：2024-08-20
投稿时间：2024-05-21 网络发布日期：2024-08-20
中文摘要: 目的 比较超声引导下外侧弓状韧带上腰方肌前侧阻滞(QLB-LSAL）和腹横肌平面阻滞（TAPB）用于腹腔镜袖状胃切除术（LSG）术中及术后的镇痛效果。方法 选择宿迁市第一人民医院2023年1月至2024年1月择期行LSG的患者90例，采用随机数字表法分为QLB-LSAL组和TAPB组，各45例。两组均于全身麻醉诱导前在超声引导下行双侧神经阻滞，均每侧单次注入0.375%罗哌卡因 20 mL。两组患者全身麻醉方法相同，术毕患者均行静脉自控镇痛（PCIA）。记录两组阻滞后不同时间的阻滞平面节段、平均动脉压(MAP)、心率(HR)、视觉模拟评分法(VAS)评分，记录术中舒芬太尼和瑞芬太尼用量、手术结束至第一次按压镇痛泵的间隔时间及术后48 h内镇痛药物用量、补救镇痛情况及不良反应发生情况。结果 QLB-LSAL组切皮后1、5 min MAP和HR，术中瑞芬太尼用量，术后2、6、12、24 h VAS评分，及术后48 h内镇痛药物用量和恶心呕吐发生率均显著低于TAPB组(P＜0.05)。QLB-LSAL组阻滞后5 min 、10 min 、6 h 、24 h的阻滞平面节段，手术结束至第一次按压镇痛泵的间隔时间多于TAPB组(P＜0.05)。两组术中舒芬太尼用量、补救镇痛率以及呼吸抑制发生率比较差异无统计学意义(P＞0.05)。结论 超声引导下QLB-LSAL联合全身麻醉可使LSG术中血流动力学更加平稳，减少术中阿片类药物用量，并提供有效的术后镇痛。
Abstract:Objective To compare the analgesic effect of ultrasound-guided anterior quadratus lumborum block at the lateral supra-arcuate ligament (QLB-LSAL) and transversus abdominis plane block (TAPB) in laparoscopic sleeve gastrectomy (LSG). Methods From January 2023 to January 2024, 90 patients underwent LSG in Suqian First People's Hospital were randomly divided into two groups: QLB-LSAL group and TAPB group, 45 cases in each group. Bilateral nerve block was performed before induction of general anesthesia, and 0.375% ropivacaine 20 mL was injected into each side of both groups. Both groups of patients received the same general anesthesia and postoperative patient-controlled intravenous analgesia (PCIA) regimen. The number of block dermatomes after block, mean arterial pressure (MAP), heart rate (HR), visual analogue scale (VAS) score were measured in different time. The intraoperative consumption of sufentanil and remifentanil, the interval time from the end of operation to the first pressing of the analgesia pump, the consumption of analgesics within 48 h after operation, the requirement for rescue analgesia, and the incidence of adverse reactions were recorded. Results The MAP and HR at 1 min and 5 min after skin incision, the intraoperative consumption of remifentanil, the VAS score at 2,6,12,24 h after operation, the consumption of analgesics within 48 h after operation, and the incidence of nausea and vomiting in QLB-LSAL group were significantly lower than those in TAPB group (P＜0.05). The number of block dermatomes at 5 min, 10 min, 6 h, 24 h after block, and the interval time from the end of operation to the first pressing of the analgesia pump in QLB-LSAL group were significantly higher than those in TAPB group (P＜0.05). There was no significant difference in the intraoperative consumption of sufentanil, the requirement for rescue analgesia, and the incidence of respiratory depression between the two groups (P＞0.05). Conclusion Ultrasound-guided QLB-LSAL combined with general anesthesia can stabilize hemodynamics, reduce the consumption of intraoperative opioids, and provide effective postoperative analgesia in patients received LSG.
keywords: Ultrasound-guided Arcuate ligament Quadratus lumborum block Transversus abdominis plane block Laparoscopic sleeve gastrectomy Ropivacaine
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| 作者 | 单位 |
| 仲明杰 | 1. 南京医科大学附属宿迁第一人民医院麻醉与围术期医学科，江苏 宿迁 223800； |
| 朱伟 | 2. 南京医科大学第一附属医院，江苏 南京 210000； |
| 从文博 | 1. 南京医科大学附属宿迁第一人民医院麻醉与围术期医学科，江苏 宿迁 223800； |
| 严志勇 | 1. 南京医科大学附属宿迁第一人民医院麻醉与围术期医学科，江苏 宿迁 223800； |
引用文本：
仲明杰,朱伟,从文博,等.超声引导下外侧弓状韧带上腰方肌前侧阻滞在减重手术中的应用[J].中国临床研究,2024,37(8):1197-1201.
仲明杰,朱伟,从文博,等.超声引导下外侧弓状韧带上腰方肌前侧阻滞在减重手术中的应用[J].中国临床研究,2024,37(8):1197-1201.