摘要
目的对比布托啡诺+右美托咪定+腹横肌平面阻滞(TAPB)与布托啡诺+右美托咪定+腰方肌阻滞(QLB)对妇科肿瘤腹腔镜手术患者的镇痛效果及加速康复的影响。方法前瞻性选取2021年1月至2022年12月在承德医学院附属医院住院治疗的100例行腹腔镜手术妇科肿瘤患者纳入本次研究,按照随机数字表法分成TAPB联合组(n=50)和QLB联合组(n=50)。TAPB联合组患者双侧均接受TAPB阻滞注射含有0.5μg/kg右美托咪定的0.375%罗哌卡因注射液20 mL+0.1%布托啡诺1 mL;QLB联合组患者双侧均行QLB阻滞注射含有0.5μg/kg右美托咪定的0.375%罗哌卡因20.0 mL+0.1%布托啡诺1 mL。比较两组患者:(1)麻醉前5 min(T_(0))、切皮前5 min(T_(1))、切皮后即刻(T_(2))、气腹解除时(T_(3))的平均动脉压(MAP)和心率;(2)术后不同时间点(2、4、8、12、24 h)的视觉模拟评分法(VAS)评分;(3)围手术期镇痛药物使用情况;(4)术后身体康复指标:包括肛门排气时间、下床活动时间、术后恢复治疗量表(QoR-40)评分和住院时间;(5)不良反应发生情况。结果两组患者在T_(0)、T_(1)和T_(3)时的心率、MAP比较,差异均无统计学意义(P>0.05);QLB联合组在T_(2)时的心率、MAP分别为(89.02±7.33)mmHg和(63.89±5.96)次/min,均显著低于TAPB联合组[(94.02±8.06)mmHg、(69.01±6.42)次/min],差异均有统计学意义(P<0.05)。QLB联合组术后2、4、8、12和24 h的VAS评分分别为(1.05±0.21)、(1.26±0.24)、(1.48±0.29)、(1.77±0.39)和(1.50±0.45)分,均显著低于TAPB联合组对应时间点[(1.25±0.26)、(1.57±0.29)、(2.17±0.32)、(2.50±0.43)和(1.81±0.53)分],差异均有统计学意义(P<0.05)。QLB联合组首次按泵时间为(14.60±1.72)h,显著长于TAPB联合组[(12.42±1.56)h],48 h按泵次数、舒芬太尼使用总量分别为(6.22±1.18)次、(102.34±10.25)μg,均显著低于TAPB联合组[(10.07±1.32)次、(129.41±11.06)μg],差异均有统计学意义(P<0.05),两组氟比洛芬酯补救镇痛人数差异无统计学意义(P>0.05)。QLB联合组术后排气时间、下床活动时间和住院时间分别为(14.52±1.67)h、(3.52±0.42)d、(9.42±2.95)d,均显著短于TAPB联合组[(15.96±1.83)h、(3.89±0.50)d和(10.89±3.20)d],且QoR-40评分为(183.96±10.36)分,显著高于TAPB联合组[(179.52±9.77)分],差异均有统计学意义(P<0.05)。QLB联合组总的不良反应发生率为10.00%,显著低于TAPB联合组(30.00%),差异有统计学意义(P<0.05)。结论相比于布托啡诺联合右美托咪定TAPB阻滞,布托啡诺联合右美托咪定QLB应用于妇科肿瘤腹腔镜术,在维持血流动力学稳定,镇痛效果方面更佳,同时还可减少术后镇痛药物的使用,并加快患者术后康复,安全性高。
Objective To compare the effects of butorphanol+dexmedetomidine for transversus abdominis plane block(TAPB)and quadratus lumborum block(QLB)on pain relief and accelerated recovery in patients undergoing laparoscopic surgery for gynecological tumors.Methods One hundred patients with gynecological tumors undergoing laparoscopic surgery hospitalized in the Affiliated Hospital of Chengde Medical University from January 2021 to December 2022 were included in this study and were divided into TAPB combined group(n=50)and QLB combined group(n=50)according to the random number table method.Both sides of patients in the TAPB combined group received TAPB block injection of 0.375%ropivacaine injection containing 0.5μg/kg dexmedetomidine 20 mL+0.1%butorphanol 1 mL.Both sides of patients in the QLB combined group received QLB block injection of 0.375%ropivacaine injection containing 0.5μg/kg dexmedetomidine 20 mL+0.1%butorphanol 1 mL.The following indicators were compared,including:(1)MAP and heart rate at 5 minutes before anesthesia(T_(0)),5 minutes before skin incision(T_(1)),immediately after skin incision(T_(2)),and when pneumoperitoneum was relieved(T_(3)).(2)Visual analogue scale(VAS)scores at different time points(2,4,8,12,24 hours)after surgery.(3)Perioperative use of analgesic drugs.(4)Postoperative physical rehabilitation indicators,including anal exhaust time,time to get out of bed activity,postoperative quality of recovery score(QoR-40)scores,and hospital stay.(5)Occurrence of adverse reactions.Results MAP and heart rate at T_(0),T_(1),and T_(3) were no statistically significant difference of the two groups(P>0.05).The MAP and HR at T_(2) in the QLB combined group were(89.02±7.33)mmHg and(63.89±5.96)times/min,respectively,which were lower than those in the TAPB combined group[(94.02±8.06)mmHg and(69.01±6.42)times/min],the differences were statistically significant(P<0.05).The VAS scores of the QLB combined group at 2,4,8,12,and 24 hours after surgery were(1.05±0.21),(1.26±0.24),(1.48±0.29),(1.77±0.39),and(1.50±0.45)points,respectively,which were lower than those of the TAPB combined group at the corresponding time points[(1.25±0.26),(1.57±0.29),(2.17±0.32),(2.50±0.43),and(1.81±0.53)points],the differences were statistically significant(P<0.05).The first pump press time in the QLB combined group was(14.60±1.72)hours,which was longer than that in the TAPB combined group[(12.42±1.56)hours],the number of pump press times and the total amount of sufentanil used during 48 hours were(6.22±1.18)times and(102.34±10.25)μg,respectively,which were lower than those of the TAPB combined group[(10.07±1.32)times and(129.41±11.06)μg],the differences were statistically significant(P<0.05).There was no statistically significant difference in the number of people receiving rescue analgesia with flurbiprofen axetil between the two groups(P>0.05).The postoperative exhaust time,ambulatory activity time,and hospitalization time in the QLB combined group were(14.52±1.67)h,(3.52±0.42)d,and(9.42±2.95)d,respectively,which were lower than those of the TAPB combined group[(15.96±1.83)h,(3.89±0.50)d,and(10.89±3.20)d],and QoR-40 score was(183.96±10.36)points,which was higher than that in the TAPB combined group[(179.52±9.77)points],the differences were statistically significant(P<0.05).The total incidence of adverse reactions in the QLB combined group was 10.00%,which was lower than that in the TAPB combined group(30.00%),the difference was statistically significant(P<0.05).Conclusion Compared with butorphanol combined with dexmedetomidine with TAPB block,butorphanol combined with dexmedetomidine with QLB is more effective in maintaining hemodynamic stability and analgesia in laparoscopic surgery for gynecological tumors,it can also reduce the use of postoperative analgesic drugs,accelerate postoperative recovery with high safety.
作者
刘燃
刘海旺
李玲
刘晶晶
LIU Ran;LIU Hai-wang;LI Ling(Department of Anesthesiology,Affiliated Hospital of Chengde Medical University,Chengde Hebei 067000,China.;Department of Pathology,Affiliated Hospital of Chengde Medical University,Chengde Hebei 067000,China.)
出处
《临床和实验医学杂志》
2023年第19期2110-2114,共5页
Journal of Clinical and Experimental Medicine
基金
承德市科技计划项目(编号:202006A045)
河北省医学科学研究课题(编号:2020005241)。
关键词
布托啡诺
镇痛
右美托咪定
腹横肌平面阻滞
腰方肌阻滞
妇科肿瘤
Butorphanol
Analgesia
Dextrmetomidine
Transversus abdominis plane block
Quadratus lumborum block
Gynecological tumors
