目的 回顾性分析腰方肌阻滞对腹腔镜肝切除术后急性疼痛的影响。 方法 选取2018年1~8月于我院行择期腹腔镜肝切除术患者24例，平均分为2组，对照组仅采用全凭静脉麻醉，腰方肌组采用腰方肌阻滞（quadratus lumborum block，QLB）联合全凭静脉麻醉，两组术后镇痛方案均为自控静脉镇痛（patient controlled intravenous analgesia，PCIA）。麻醉期间常规监测患者心率、血压、脉搏氧饱和度，采用腰方肌阻滞的患者在阻滞完成后15 min记录阻滞平面。分别于术前、术后2 h、术后8 h、术后12 h、术后24 h和术后48 h对患者进行VAS评分。记录患者术中和术后PCIA阿片类药物消耗情况及术后48 h内恶心呕吐、尿潴留、瘙痒和呼吸抑制等并发症发生情况。 结果 腰方肌组患者在术后2、8、12 h 3个时间点VAS评分显著低于对照组，差异具有统计学意义（P<0.05）。腰方肌组12名患者最高阻滞平面为T6（T6~10），最低阻滞平面为L1（T12~L1）。与对照组相比，腰方肌组术中和术后PCIA阿片类药物消耗均显著减少，差异具有统计学意义（P<0.05）。 结论 腰方肌阻滞能够有效缓解腹腔镜肝切除术患者术后急性期疼痛，减少围术期阿片类药物用量。
Abstract
Objective To retrospectively analyze the effect of quadratus lumborum block on postoperative acute pain of patients undergwent laparoscopic hepatectomy. Methods Twenty-four patients who underwent selective laparoscopic hepatectomy under total intravenous general anesthesia in our hospital from January to August 2018 were selected. Patients who only accepted total intravenous general anesthesia were assigned to the control group. Patients who accepted total intravenous general anesthesia (TIVA) combined with quadratus lumborum block (QLB) were assigned to the QLB group. All patients accepted patient controlled intravenous analgesia (PCIA) for postoperative analgesia. Heart rate, blood pressure, and pulse oximetry were routinely monitored during anesthesia. The blocked area of patients was tested and recorded 15 min after quadratus lumborum block. VAS scores were obtained before surgery, and 2 h, 8 h, 12 h, 24 h, and 48 h after surgery. Opioids consumption during the operation and PCIA were also recorded. Additionally, postoperative complications such as nausea and vomiting, urinary retention, itching and respiratory depression during 48 h after surgery were also recorded. Results VAS scores in QLB group were significantly lower than those in the control group at 2, 8 and 12 h postoperatively. And the difference was statistically significant (P<0.05). The highest and the lowest block plane of the 12 patients in QLB group was T6 (T6~10) and L1 (T12~L1), respectively. Compared with the control group, the opioids consumption during the operation and PCIA of QLB group was significantly decreased and the difference was statistically significant (P<0.05). Conclusions Quadratus lumborum block can effectively relieve postoperative acute pain in patients undergoing laparoscopic hepatectomy and reduce the opioids consumption during perioperative period.
关键词
腰方肌阻滞 /
肝切除术 /
疼痛 /
回顾性分析
Key words
Quadratus lumborum block /
Hepatectomy /
Pain /
Retrospective study
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参考文献
[1] Neal JM, Brull R, Chan VW, et al. The ASRA evidence-based medicine assessment of ultrasound-guided regional anesthesia and pain medicine: executive summary[J]. Reg Anesth Pain Med, 2010, 35(2 Suppl): S1-S9.
[2] Go R, Huang YY, Weyker PD, et al. Truncal blocks for perioperative pain management: a review of the literature and evolving techniques[J]. Pain Manag, 2016, 6(5): 455-468.
[3] 朱炜楷, 隋鸿锦, 付元山, 等. 胸腰筋膜解剖结构的研究进展[J]. 中国临床解剖学杂志, 2016, 34(3): 355-358.
[4] Blanco R. Tap block under ultrasound guidance: the description of a “no pops” technique[J]. Reg Anesth Pain Med, 2007, 32(5): 130.
[5] Blanco R, Ansari T, Girgis E. Quadratus lumborum block for postoperative pain after caesarean section: a randomised controlled trial[J]. Eur J Anaesthesiol, 2015, 32(11): 812-818.
[6] Ishio J, Komasawa N, Kido H, et al. Evaluation of ultrasound-guided posterior quadratus lumborum block for postoperative analgesia after laparoscopic gynecologic surgery[J]. J Clin Anesth, 2017, 41: 1-4.
[7] Sindwani G, Sahu S, Suri A, et al. Bilateral quadratus lumborum block for postoperative analgesia in a Von Hippel-Lindau syndrome patient undergoing laparoscopic radical nephrectomy[J]. Saudi J Anaesth, 2017, 11(4): 513-514.
[8] Elsharkawy H. Quadratus lumborum blocks[J]. Adv Anesth, 2017, 35(1): 145-157.
[9] Ueshima H, Otake H, Lin JA. Ultrasound-guided quadratus lumborum block: an updated review of anatomy and techniques[J]. Biomed Res Int, 2017, 2017: 2752876.
[10] 中华医学会外科学分会外科手术学学组, 中国医疗保健国际交流促进会, 加速康复外科学分会肝脏外科学组. 肝切除术后加速康复中国专家共识（2017版）[J]. 临床肝胆病杂志, 2017, 33(10): 254-260.
[11] 朱斌, 黄建宏. 加速康复外科在我国发展现状、挑战与对策[J]. 中国实用外科杂志, 2017, 37(1): 26-29.
[12] Rozen WM, Tran TM, Ashton MW, et al. Refining the course of the thoracolumbar nerves: a new understanding of the innervation of the anterior abdominal wall[J]. Clin Anat, 2010, 21(4): 325-333.
[13] 陈建国, 陈万青, 张思维, 等. 中国2003-2007年肝癌发病率与死亡率分析[J]. 中华流行病学杂志, 2012, 33(6): 547-553.
[14] Page A, Rostad B, Staley CA. Epidural analgesia in hepatic resection[J]. J Am Coll Surg, 2008, 206(6): 1184-1192.
[15] Abdelsalam K, Mohamdin OW. Ultrasound-guided rectus sheath and transversus abdominis plane blocks for perioperative analgesia in upper abdominal surgery: a randomized controlled study[J]. Saudi J Anaesth, 2016, 10(1): 25-28.
基金
广东省科技计划项目（2014A020212170）
京ICP备08002354号-3
