摘要
目的比较超声引导下腹横肌平面阻滞(TAPB)与腰方肌阻滞(QLB)在腹腔镜子宫肌瘤剔除术中的应用效果。方法选择2019年12月至2020年12月焦作市妇幼保健院收治的98例子宫肌瘤患者为研究对象,所有患者行腹腔镜子宫肌瘤剔除术,根据麻醉方法将患者分为TAPB组和QLB组,每组49例。TAPB组患者给予超声引导下TAPB,QLB组患者给予超声引导下QLB,然后均实施全身麻醉。记录2组患者麻醉前(T_(0))、切皮时(T_(1))、肌瘤剔除时(T_(2))及术毕时(T_(3))的心率(HR)和平均动脉压(MAP);观察2组患者的苏醒质量,包括气管插管拔出时间、呼之睁眼时间、恢复室停留时间,并统计术后24 h内患者自控静脉镇痛(PCIA)次数;术后6、12、24 h,采用视觉模拟评分法(VAS)评估患者疼痛程度,采用Ramsay评分评估患者镇静程度;观察2组患者不良反应发生情况。结果2组患者T_(1)、T_(2)时HR、MAP显著高于T_(0)时(P<0.05),T_(3)时HR、MAP显著低于T_(1)、T_(2)时(P<0.05),T_(3)与T_(0)时HR、MAP比较差异无统计学意义(P>0.05);T_(0)、T_(1)、T_(2)、T_(3)时2组患者HR、MAP比较差异无统计学意义(P>0.05)。QLB组患者呼之睁眼时间、气管插管拔出时间、恢复室停留时间显著短于TAPB组,术后24 h内PCIA次数显著少于TAPB组(P<0.05)。2组患者术后12、24 h时VAS评分显著高于术后6 h时(P<0.05),2组患者术后24 h时VAS评分显著高于术后12 h时(P<0.05);术后6、12、24 h时,QLB组患者VAS评分显著低于TAPB组(P<0.05)。2组患者术后24 h时Ranm say评分显著高于术后6、12 h(P<0.05),2组患者术后12 h时Ranmsay评分与术后6 h时比较差异无统计学意义(P>0.05);术后6、12、24 h时2组患者Ranmsay评分比较差异无统计学意义(P>0.05)。TAPB组和QLB组患者不良反应发生率分别为10.20%(5/49)、6.12%(3/49),2组患者不良反应发生率比较差异无统计学意义(χ^(2)=0.136,P>0.05)。结论超声引导下TAPB、QLB均可维持腹腔镜子宫肌瘤剔除术患者的血流动力学稳定,且镇静效果较好。相比超声引导下TAPB,超声引导下QLB的镇痛效果更好,可有效减少PCIA次数,提高患者术后苏醒质量。
Objective To compare the application effect of ultrasound-guided transversus abdominis plane block(TAPB)and quadratus lumborum block(QLB)in laparoscopic myomectomy.Methods A total of 98 patients with uterine fibroids admitted to the Maternal and Child Health Hospital of Jiaozuo City from December 2019 to December 2020 were selected as the research subjects,all patients underwent laparoscopic myomectomy,and the patients were divided into TAPB group and QLB group according to the anesthesia method,with 49 cases in each group.The patients in the TAPB group were given ultrasound-guided TAPB,and the patients in the QLB group were given ultrasound-guided QLB,and then all patients received general anesthesia.The heart rate(HR)and mean arterial pressure(MAP)of patients in the two groups were recorded at the time points of before anesthesia(T_(0)),skin incision(T_(1)),during myomectomy(T_(2))and the end of operation(T_(3)).The quality of recovery of patients in the two groups was observed,including the extubation time,eye opening time,and recovery room residence time;and the number of patient-controlled intravenous analgesia(PCIA)within 24 hours after operation was counted.At 6,12 and 24 hours after operation,the degree of pain was evaluated by visual analogue scale(VAS),and the degree of sedation was evaluated by Ramsay score.The adverse reactions of patients in the two groups were observed.Results The HR and MAP at T_(1) and T_(2) in the two groups were significantly higher than those at T_(0)(P<0.05),the HR and MAP at T_(3) were significantly lower than those at T_(1) and T_(2)(P<0.05),and there was no significant difference in HR and MAP between T_(3) and T_(0)(P>0.05).There was no significant difference in HR and MAP between the two groups at T_(0),T_(1),T_(2) and T_(3)(P>0.05).The extubation time,eye opening time and recovery room residence time of patients in the QLB group were significantly shorter than those in the TAPB group,and the number of PCIA within 24 hours after operation was significantly less than that in the TAPB group(P<0.05).The VAS score at 12 and 24 hours after operation in both groups were significantly higher than those at 6 hours after operation(P<0.05).The VAS score at 24 hours after operation in both groups were significantly higher than those at 12 hours after operation(P<0.05).The VAS score of patients in the QLB group was significantly lower than that in the TAPB group at 6,12,and 24 hours after operation(P<0.05).The Ranmsay score at 24 hours after surgery in the two groups was significantly higher than that at 6 and 12 hours after operation(P<0.05).There was no significant difference in the Ranmsay score between 12 hours and 6 hours after operation in the two groups(P>0.05).There was no significant difference in the Ranmsay score between the two groups at 6,12 and 24 hours after operation(P>0.05).The incidence of adverse reactions in the TAPB group and QLB group was 10.20%(5/49)and 6.12%(3/49),respectively.There was no significant difference in the incidence of adverse reactions between the two groups(χ^(2)=0.136,P>0.05).Conclusion Ultrasound-guided TAPB and QLB can both maintain hemodynamic stability in patients with laparoscopic myomectomy,and have better sedation effect.Compared with ultrasound-guided TAPB,ultrasound-guided QLB has better analgesic effect,can effectively reduce the number of PCIA,and improve the quality of patients′postoperative recovery.
作者
王卫华
杨红军
王尚柯
茹六合
郑小虎
WANG Weihua;YANG Hongjun;WANG Shangke;RU Liuhe;ZHENG Xiaohu(Department of Anesthesiology,Maternal and Child Health Hospital of Jiaozuo City,Jiaozuo 454000,Henan Province,China)
出处
《新乡医学院学报》
CAS
2022年第2期182-186,共5页
Journal of Xinxiang Medical University
关键词
子宫肌瘤
子宫肌瘤剔除术
腹腔镜手术
腹横肌平面阻滞
腰方肌阻滞
hysteromyoma
myomectomy
laparoscopic surgery
transversus abdominis plane block
quadratus lumborum block
作者简介
王卫华(1978-),男,河南焦作人,学士,副主任医师,主要从事临床麻醉工作。
