腰方肌阻滞与腹横肌平面阻滞应用于妇科腹腔镜术后镇痛效果的比较

目的 分析腰方肌阻滞（quadratus lumborum block,QLB）与腹横肌平面阻滞（transversus abdominis plane block,TAP）应用于妇科腹腔镜术后镇痛的效果。 方法 选取择期行腹腔镜卵巢瘤切除术患者50例分为2组，QLB组和TAP组各25例。两组均采用气管插管全凭静脉麻醉，在麻醉诱导前，QLB组行双侧QLB，TAP组行双侧TAP，术后均采用静脉自控镇痛。比较术后2，6，12，24，48 h患者静息疼痛视觉模拟评分法（visual analogue scale，VAS）评分；比较术后首次按压镇痛泵时间、48 h内镇痛泵有效按压次数、舒芬太尼使用总量和氟比洛芬酯补救性镇痛例数；比较术后48 h不良反应发生情况。 结果 2组各时点静息疼痛VAS评分呈先逐渐上升随后再下降趋势，术后24 h疼痛最严重，且QLB组低于TAP组，组间、时点间、组间·时点间交互作用差异均有统计学意义（P＜0.05）。与TAP组比较，QLB组首次按压镇痛泵时间明显延长（P＜0.05），48 h内镇痛泵有效按压次数、舒芬太尼使用总量和氟比洛芬酯补救镇痛例数明显降低（P＜0.05），QLB组术后48 h不良反应发生率明显降低（P＜0.05）。 结论 与TAP比较，QLB镇痛效果更加完善，作用时间更长并减少术后阿片类药物应用，更适合应用于妇科腹腔镜术后多模式镇痛。

Comparison of the analgesic effect of quadratus lumborum block and transversus abdominis plane block in gynecological laparoscopic surgery

Objective To analyze the analgesic effect of quadratus lumborum block and transversus abdominis plane block in gynecological laparoscopic surgery.Methods Fifty patients undergoing laparoscopic ovarian tumor resection were selected and divided into two groups. They were quadratus lumborum block(QLB) group and transverse abdominis plane block(TAP) group, 25 cases in each group. Tracheal intubation and total intravenous anesthesia were used in both groups.Before anesthesia induction, QLB group received bilateral quadratus lumborum block, TAP group received bilateral transversus abdominis plane block. Patient controlled intravenous analgesia was used postoperatively in both groups. The following indexes were compared between the two groups, including visual analogue scale(VAS) score of resting pain at 2, 6, 12, 24, 48 hours after operation, the time of first pressing analgesia pump, the effective pressing times of analgesia pump within 48 hours, the total amount of sufentanil used and the number of cases of remedial analgesia with flurbiprofen axetil, the incidence of adverse reactions at 48 hours after operation.Results The VAS score of resting pain at each time point in the two groups showed a gradual increase and then a downward trend. The most severe pain occurred 24 hours after operation, and the QLB group was lower than the TAP group. The differences between intergroup, time point and interaction of intergroup and time point of two groups had the statistically significant(P＜0.05). Compared with the TAP group, the first pressing time of analgesia pump in the QLB group was significantly longer(P＜0.05), the effective pressing times of analgesia pump within 48 hours, the total use of sufentanil and the number of cases of rescue analgesia with flurbiprofen axetil were significantly decreased in the QLB group (P＜0.05), and the incidence of adverse reactions at 48 hours after operation in the QLB group was significantly lower than that in the TAP group(P＜0.05).Conclusion Compared with transversus abdominis plane block, quadratus lumborum block has more perfect analgesic effect, longer action time and less opioid application, which is more suitable for multimodal analgesia after gynecological laparoscopic surgery.