摘要
目的观察超声引导下腰方肌阻滞（quadratus lumbommblock，QLB）与腹横肌平面阻滞（transversus abdominis plane block，TAPB）对经腹全子宫切除术后镇痛效果的影响及恢复情况。方法选取全身麻醉下行经腹全子宫切除的患者，采用随机数字表法分为两组（每组30例）：QLB组和TAPB组。术后即刻分别行QLB及TAPB，两组均行患者自控静脉镇痛（patient controlled intravenous analgesia，PCIA），采用VAS评估术后4、8、12h和24h不同时间点静息及咳嗽时VAS评分，观察两组阻滞扩散的平面，术后恢复及副作用的情况。结果QLB组的阻滞平面扩散至T7～L1；TAPB组的阻滞平面扩散至T10～L1；术后4、8h的VAS评分两组差异无统计学意义（P〉0．05），QLB组术后12h及术后24h的静息与咳嗽时VAS评分均低于TAPB组（P〈0．05）；术后24h内需要镇痛补救的发生率、术后恶心呕吐的发生率及肛门排气时间两组差异无统计学意义（P〉0．05）。结论相比较TAPB，QLB可以为经腹全子宫切除术提供更好的镇痛效果，且镇痛效果持续更长。
Objective To examine analgesic effects of ultrasound-guided quadratus lumborum block （QLB） and transversus abdominis plane block （TAPB） on recovery from total abdominal hysterectomy. Methods Patients scheduled for total abdominal hysterectomy were randomly divided into two groups （n=30）, group QLB and group TAPB. Patients in both groups were given patientcontrolled intravenous analgesia （PCIA）. Pain both at rest and during cough were quantified with VAS 4, 8, 12 h and 24 h after the operation. Information about diffusion of nerve block and the use of extra analgesic drugs, postoperative recovery and complications were also collected. Results QLB diffused to the regions innervated by the T7-L1 nerves, whereas TAPB affected regions innervated by T10-L1 nerves. Patients received QLB reported lower VAS scores during rest and cough than those received TAPB 12 h and 24 h after operation （P〈0.05）. No significant difference between QLB and TAPB groups was observed in the use of extra analgesic drugs 24 h after surgery, the incidence of nausea and vomiting, time to recovery of bowel function, etc （P〉0.05）. Conclusions QLB provides more effective analgesia than TAPB in patients undergoing total abdominal hysterectomy.
作者
朱明慧
汤洋
许倩
秦勤
陈燕
Zhu Minghui;Tang Yang;Xu Qian;Qin Qin;Chen Yan(Department of Anesthesiology,Affiliated Hospital of Nanjing University of TCM,Nanjing 210000,China)
出处
《国际麻醉学与复苏杂志》
CAS
2018年第8期741-745,共5页
International Journal of Anesthesiology and Resuscitation
关键词
腰方肌阻滞
腹横肌平面阻滞
子宫切除术
镇痛
Quadratus lumborum block
Transversus abdominis plane block
Total abdominal hysterectomy
Analgesia
