后路腰方肌阻滞与肋缘下腹横肌平面阻滞在腹腔镜胆囊切除术后镇痛中的效果对比

Comparative study of analgesic effect of posterior quadratus lumbar block and subcostal transverse abdominis plane block after laparoscopic cholecystectomy

摘要:

目的 探讨超声引导下后路腰方肌阻滞（QLB）和超声引导下肋缘下腹横肌平面阻滞（STAPB）用于腹腔镜胆囊切除术（LC）后的镇痛效果。方法 选择2020年6月－2020年12月行择期LC的患者60例，采用随机数表法分为QLB组（n = 30）和STAPB组（n = 30）。全身麻醉诱导前，QLB组行双侧超声引导下后路QLB，STAPB组行双侧超声引导下STAPB，术后均采用静脉自控镇痛。观察两组患者术后首次行走时间，首次按压镇痛泵时间，氟比洛芬酯补救次数，术后1、4、8、12、24和48 h静息和运动状态的视觉模拟评分（VAS），围术期各时段舒芬太尼用量，术后48 h不良反应发生情况等。结果 与STAPB组比较，QLB组术后首次按压镇痛泵时间明显延长，首次行走时间明显缩短，术后12 h静息VAS及术后4、8、12和24 h运动VAS明显降低，术后0～12 h、12～24 h和24～36 h舒芬太尼消耗量明显减少（P < 0.05）。QLB组术后48 h不良反应总发生率低于STAPB组（P < 0.05）。结论 超声引导下后路QLB较超声引导下STAPB能更有效地降低LC术后运动VAS，延长镇痛时间，减少围术期阿片类药物的使用量，降低不良反应发生率，加速患者康复。

Abstract:

Objective To evaluate the effect of ultrasound-guided posterior quadratus lumborum block (QLB) and subcostal transverse abdominis plane block (STAPB) in laparoscopic cholecystectomy (LC).Methods 60 patients with LC from June 2020 to December 2020 were selected, and were divided into QLB group (n = 30) and STAPB group (n = 30). Before induction of general anesthesia, bilateral ultrasound-guided posterior QLB was performed in QLB group and bilateral ultrasound-guided STAPB was performed in STAPB group, all the patients controlled intravenous analgesia was used after operation. The time of first walking after operation, the time of first pressing analgesia pump, the times of recovery of flurbiprofen axetil, the visual analogue scale (VAS) at 1, 4, 8, 12, 24 and 48 h after operation, the dosage of sufentanil in each period of perioperative period and the incidence of adverse reactions in 48 h after operation were observed.Results Compared with STAPB group, the time of first pressing analgesia pump in QLB group was longer, the first walking time was significantly shortened, the resting VAS score at 12 h after operation and the exercise VAS at 4, 8, 12 and 24 h after operation were significantly lower, and the consumption of sufentanil at 0~12 h, 12~24 h and 24~36 h after operation in QLB group was significantly decreased (P < 0.05); The total incidence of adverse reactions 48 hours after operation in QLB group was lower than that in STAPB group (P < 0.05).Conclusion Ultrasound-guided posterior QLB is more effective than ultrasound-guided STAPB in reducing the postoperative VAS, prolonging the analgesia time and reducing the use of opioids in perioperative period, so as to reduce the incidence of adverse reactions and accelerate the recovery of patients.