摘要
目的探讨超声引导下腰方肌阻滞(quadratus lumborum block,QLB)在经腹直肠癌根治术后的镇痛效果。方法选择2016年2月至2017年3月在我院择期行经腹直肠癌根治术患者60例,男36例,女24例,年龄30~70岁,ASAⅠ或Ⅱ级,采用随机数字表法随机分为全麻联合QLB组(QLB组)和单纯全麻组(C组),每组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0.375%罗哌卡因20ml,C组行单纯全麻。观察两组患者切皮前即刻、切皮后5min的SBP、DBP和HR,计算并记录其差值(切皮后-切皮前);记录术中芬太尼用量、术后镇痛泵首次按压时间、舒芬太尼用量、补救性镇痛次数、首次下床活动时间和术后镇痛满意度。结果 QLB组切皮前即刻、切皮后5min SBP、DBP和HR差值均明显小于C组(P<0.05);术中芬太尼用量明显少于C组(P<0.05);镇痛泵首次按压时间明显晚于C组(P<0.05);术后0~12h、12~24h的舒芬太尼用量明显少于C组(P<0.05);补救性镇痛发生率明显低于C组(P<0.05);首次下床时间明显早于C组(P<0.05);术后镇痛满意度明显高于C组(P<0.05)。结论全麻联合0.375%罗哌卡因行双侧腰方肌阻滞可明显减少经腹直肠癌根治术患者术后阿片类药物用量,患者术后下地时间明显提前,术后镇痛效果满意,提高患者的舒适度。
Objective To investigate the analgesia effects and duration of ultrasound-guided quadratus lumborum block（QLB）in radical resection of rectal cancer,and to evaluate its clinical effect,so as to provide new clinical ideas for intraoperative and postoperative analgesia.Methods Sixty patients who would undergo expected radical resection of transabdominal rectal cancer in our hospital from February,2016 to March,2017 were selected,of which 36 males and 24 females,aged 30-70 years,ASA physical status Ⅰ or Ⅱ.They were randomly divided into two groups,30 cases in each.After induction,the patients in group QLB underwent ultrasound-guided bilateral QLB before surgury,40 ml of 0.375% ropivacaine was given to these patients.Patients in group C received general anesthesia alone.The values of systolic pressure（SBP）,diastolic pressure（DBP）,heart rate（HR）immediately before and 5 minutes after cutting were oberserved and recorded.The patients＇ incision reaction,the dosage of fentanyl intraoperative,the visual analogue scores（VAS）of 2,4,6,12,24,and 48 hours after operation,the first time pressing the analgesic pump button,the consumption of sufentanil,times of remedial analgesia,the time getting out of bed,the patient＇s satisfaction with postoperative analgesia were recorded in the two groups.Results The changes of SBP,DBP and HR 5 min before and after skin incision in group QLB were significantly lower than those in group C（P〈0.05）.The usage of fentanyl in group QLB significantly decreased compared with that in group C（P 〈0.01）.The first time pressing the analgesic pump button in group QLB was significantly later than that in group C（P〈0.05）.The usage of sufentanil significantly decreased in QLB group at 2,4,6,12 and 24 hours after operation compared with that in group C（P〈0.05）.The times of remedial analgesia in group QLB were lower than that in group C（P〈0.05）.The time getting out of bed and exhausting in group QLB were significantly earlier compared with those in group C（P〈0.05）.The patient＇s satisfaction with postoperative analgesia was significantly higher in group QLB compared with that in group C（P〈0.05）.Conclusion Bilateral quadratus lumborum blockage with 0.375% ropivacaine can reduce the opioid consumption for patients undergoing radical surgery of rectal cancer,and postoperative opioid usage was also reduced.The time getting out of the bed in group QLB was significantly shifted to an earlier date compared with those in group C.It can provide a satisfactory analgesia,and improve the patient＇s comfort and satisfaction.
作者
李刚
张建欣
LI Gang ZHANG Jianxin.(Department of Anesthesiology, the 148th Hospital of Chinese People＇s Liberation Army, Zibo 255300, China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2017年第10期987-990,共4页
Journal of Clinical Anesthesiology
关键词
超声引导
腰方肌阻滞
直肠癌根治术
镇痛
Ultrasound guidance
Quadratus lumborum block
Radical resection of rectal cancer
Analgesia
