超声引导下腰方肌阻滞或腹横筋膜阻滞联合PCIA在老年下腹部手术镇痛的应用

目的 观察超声引导下腰方肌阻滞（QLB）或腹横筋膜阻滞（TAP）联合静脉自控镇痛（PCIA）在老年下腹部手术术后镇痛效果。方法 采用随机数字表法将90例全身麻醉下择期行腔镜直肠癌根治的老年手术病人，分成3组各30例:QLB组、TAP组、单纯全麻组（S组）。观察病人各项指标，记录术后4、8、12、24、48 h不同时点舒芬太尼总用量，记录病人术后4、8、12、24、48 h不同时点静息及运动时VAS评分，记录病人术后不良反应及镇痛满意度。结果 与S组比较，QLB和TAP在术后各时点舒芬太尼消耗量少于S组（P < 0.01）；QLB和TAP在术后各时点静息及运动时VAS评分低于S组（P < 0.01）。与TAP组比较，QLB组在术后各时点舒芬太尼消耗量少于TAP组（P < 0.01）；QLB组术后各时点静息时VAS评分低于TAP组（P < 0.01），术后4 h运动时VAS评分，QLB与TAP组差异无统计学意义（P>0.05）；QLB组术后镇痛满意度高于TAP组和S组（P < 0.01）；结论 超声引导下双侧QLB使病人达到满意的镇痛效果，减少术中及术后阿片类药物的用量，镇痛满意度优于TAP。

Clinical observation of the quadratus lumborum and fascia trans versalis block guided by ultrasound combined with PCIA in the analgesia of lower abdominal surgery in the elderly

Objective To observe the analgesic effects of the quadratus lumborum block(QLB) and transversus abdomins plane guided by ultrasound combined with PCIA in the elderly after lower abdominal surgery.Methods Ninety elderly patients scheduled by endoscopic radical resection of rectal cancer under general anesthesia were randomly divided into the quadratus lumbosus block group(QLB group, 30 cases), fascia trans versalis block group(TAP group, 30 cases) and simple general anesthesia group(S group, 30 cases) using the random number table method.The various indexes in three groups were observed.The total amount of sufentanil, and VAS scores of rest and exercise after 4, 8, 12, 24 and 48 hours in three groups were recorded, and the postoperative adverse reaction and analgesic satisfaction of patients were evaluated.Results The total amount of sufentanil in QLB group and TAP group at each postoperative time-point were less than that in S group(P < 0.01), and the VAS scores of rest and exercise in QLB group and TAP group at each postoperative time-point were less than that in S group(P < 0.01).The total amount of sufentanil in QLB group at each postoperative time-point was less than that in TAP group(P < 0.01), and the VAS score of rest in QLB group at each postoperative time-point was less than that in TAP group(P < 0.01).The difference of the VAS score of exercise between QLB group and TAP group at postoperative 4 h was not statistically significant(P>0.05).The postoperative analgesic satisfaction in QLB group was higher than that in TAP group and S group(P < 0.01).Conclusions The quadratus lumborum block guided by ultrasound can achieve satisfactory analgesic effect and reduce the use of opioids during and after surgery, and the analgesic satisfaction of which is better than that of fascia trans versalis block.