摘要
目的:探讨超声引导下腰方肌阻滞(quadratus lumborum block,QLB)对阑尾切除术术后镇痛效果和恢复情况的影响。方法:选取2017-07~2018-07我院全麻下行经典开腹阑尾切除术患者100例,采用随机数字表法分为腰方肌阻滞组(QLB组)和对照组(C组),每组50例。两组均在术毕立即行超声引导下右侧QLB,QLB组给予0.25%罗哌卡因20 ml;C组给予0.9%生理盐水20 ml。记录并比较两组术后4、8、12、24 h的疼痛视觉模拟评分(visual analogue score,VAS)及术后0~12、12~24、24~48 h不同时段舒芬太尼用量和48 h总消耗量。记录并比较两组首次下床活动时间、肛门排气时间、术后曲马多追加例数和满意度VAS评分。记录局麻药中毒、血肿、感染、内脏损伤等QLB并发症情况及恶心呕吐、瘙痒、眩晕、尿潴留、低氧血症等不良反应发生情况。结果:QLB组术后4、8、12、24 h疼痛VAS评分明显低于C组(P<0.05),但两组间48 h疼痛VAS评分比较无明显差异;术后0~12、12~24、24~48 h舒芬太尼用量和总消耗量均明显低于C组(P<0.05),曲马多追加例数明显少于C组(P<0.05),满意度VAS评分明显高于C组(P<0.05)。两组首次下床时间和肛门排气时间比较,差异无统计学意义。所有患者均穿刺顺利,无一例出现局麻药中毒、血肿、感染、内脏损伤等并发症。QLB组术后恶心呕吐、瘙痒、眩晕发生率明显低于C组(P<0.05)。结论:超声引导下QLB用于阑尾切除术术后镇痛效果明显,可减少术后阿片药物用量,且不良反应少,是一种安全有效的术后镇痛方法。
Objective:To investigate the effect of ultrasound-guided quadrants lumborum block(QLB)on the postoperative analgesia and recovery of appendectomy.Methods:One hundred patients with classic open appendectomy under general anesthesia were enrolled and randomly divided into QLB group(n=50)and control group(group C,n=50),which were respectively injected 0.25%ropivacaine 20 ml and 0.9%normal saline 20 ml.All patients accepted ultrasound-guided right sided QLB block immediately at the end of surgery.The postoperative VAS scores of the two groups at 4 h,8 h,12 h and 24 h,the doses of sufentanil at 0-12 h,12-24 h and 24-48 h and total consumption within 48 h between the two groups were observed and compared.First time out of bed,anal exhaust time,number of remedial tramadol analgesic patients and the VAS score of satisfaction between the two groups were recorded and compared.Record the complications of local anesthetic poisoning,hematoma,infection,visceral injury and other QLB complications,and recorded adverse reactions such as nausea and vomiting,itching,dizziness,urinary retention,and hypoxemia.Results:The patient′s VAS scores in QLB group were significantly lower than that in group C at postoperative 4 h,8 h,12 h,and 24 h(P<0.05),but no significant difference between the two groups at 48 h.The dosage at 0-12 h,12-24 h,24-48 h and total consumption of sufentanil within 48 h of QLB group were significantly lower than that of group C(P<0.05).The number of remedial tramadol analgesic patients of QLB group was significantly less than that of the group C(P<0.05).The satisfaction VAS scores in QLB group were significantly higher than that in group C.The first time getting out of bed and anus exhaust between the two groups has no significant difference.There was no complications occurred.The incidence rates of postoperative nausea and vomiting,pruritus and dizziness in QLB group were significantly lower than those in group C(P<0.05).Conclusion:Ultrasound-guided QLB for postoperative analgesia after appendectomy significantl
作者
曹慧灵
谢科宇
刘佳
CAO Huiling;XIE Keyu;LIU Jia(Department of Anesthesia,Chengdu Second People′s Hospital,Chengdu 610000,China)
出处
《西北国防医学杂志》
CAS
2019年第11期677-681,共5页
Medical Journal of National Defending Forces in Northwest China
基金
四川省卫生和计划生育委员会科研课题-普及应用项目(18PJ164)
关键词
腰方肌阻滞
术后镇痛
阑尾切除术
术后恢复
quadratus lumborum block
postoperative analgesia
appendectomy
postoperative recovery
