国际麻醉学与复苏杂志   2020, Issue (7): 0-0
    
腰方肌阻滞与腹横肌平面阻滞在腹腔镜结直肠癌根治术后镇痛中的比较
蔡朦朦, 葛建林, 缪娟娟, 宋杰, 杜伯祥1()
1.南通大学第二附属医院(南通市第一人民医院)麻醉科
Comparison of quadratus lumborum block and transversus abdominis plane block for postoperative analgesia in laparoscopic resection of colorectal cancer
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摘要:

目的 观察超声引导下腹横肌平面阻滞(transversus abdominis plane block, TAPB)与腰方肌阻滞(quadratus lumborum block, QLB)对腹腔镜结直肠癌根治术后镇痛效果的影响。 方法 选取全身麻醉下行腹腔镜结直肠癌根治术的患者,采用随机数字表法分为两组(每组45例):TAPB组和QLB组。术后患者清醒并拔除气管导管后分别行TAPB和QLB,两组均行患者自控静脉镇痛(patient controlled intravenous analgesia, PCIA),术中记录手术时间、失血量、补液量、瑞芬太尼消耗量及使用阿托品的患者例数;观察两组冷感觉消失的平面;记录术后0~6 h、6~12 h、12~24 h及24~48 h PCIA按压次数及术后不良反应情况。 结果 两组患者手术时间、术中失血量、术中补液量、瑞芬太尼消耗量及使用阿托品的患者例数差异无统计学意义(P>0.05)。TAPB组多数患者冷感觉消失的平面在T10~L1,QLB组多数患者冷感觉消失的平面在T7~L1;与TAPB组比较,QLB组患者术后0~6 h、6~12 h和12~24 h 时段PCIA按压次数明显减少(P<0.05),术后恶心呕吐、眩晕的发生率明显降低(P<0.05)。 结论 与TAPB相比,QLB可以为腹腔镜结直肠癌根治术患者提供更好的镇痛效果,且镇痛持续时间更长。

关键词: 结直肠癌; 腹腔镜治疗; 腹横肌平面阻滞; 腰方肌阻滞; 术后镇痛
Abstract:

Objective This paper investigates the analgesic effects of ultrasound‑guided transversus abdominis plane block (TAPB) and quadratus lumborum block (QLB) in laparoscopic resection of colorectal cancer. Methods Patients undergoing laparoscopic radical surgery of colorectal cancer with general anesthesia, were divided into two groups according to random number table method (n=45): TAPB group and QLB group. Bilateral subcostal TAPB was performed under ultrasound guidance in TAPB group after the patients were awake and had the endotracheal tube removed. Bilateral paravertebral approach to QLB was performed under ultrasound guidance in GLB group. Patients in both groups were given patient controlled intravenous analgesia (PCIA). Time of operation, blood loss, fluid infusion, remifentanil consumption and the number of patients using atropine were recorded during operation. Information about diffusion planes of nerve block, the pressing times of PCIA during 0‒6 h, 6‒12 h and 12‒24 h after the operation, as well as the postoperative complications were also recorded. Results There were no significant difference in time of operation, blood loss, fluid infusion, remifentanil consumption and the number of patients using atropine between the two groups (P>0.05). TAPB diffused to the area innervated by the T10‒Ll spinal nerves,whereas QLB diffused to the area innervated by T7‒Ll spinal nerves. Compared with TAPB group, the pressing times of PCIA in QLB group significantly decreased during 0‒6 h, 6‒12 h and 12‒24 h (P<0.05). The incidence of postoperative nausea, vomiting and vertigo was markedly reduced (P<0.05). Conclusions QLB provides more effective and longer lasting analgesia than TAPB in patients undergoing laparoscopic resection of colorectal cancer.

Key words: Colorectal cancer; Therapeutic laparoscopy; Transversus abdominis plane block; Quadratus lumborum block; Postoperative analgesia