腰方肌阻滞用于老年患者肾癌根治术的镇痛效果评价

目的:评价腰方肌阻滞(quadratus lumborum block,QLB)用于老年患者后腹腔镜肾癌根治术的镇痛效果。方法:选择2017年6月至2018 年6月在我院择期行后腹腔镜肾癌根治术患者60例,年龄65~76 岁,ASA I-Ⅲ级,采用随机数字表法分为全麻联合腰方肌阻滞组(Q 组)和单纯全麻组(C组),每组30例。Q组患者于全麻诱导后行超声引导下术侧腰方肌阻滞，C组行单纯全麻。两组术后均使用静脉自控镇痛，视觉模拟评分（VAS）大于6分时5 mg地佐辛静注行补救镇痛。记录两组患者切皮前（T0）、切皮后5 min （T1）的收缩压（SBP）、舒张压（DBP）和心率（HR），计算切皮前后差值，记录术后6、12和24 h VAS评分，记录术中瑞芬太尼用量、术后镇痛泵首次按压时间、舒芬太尼用量、补救性镇痛次数、术后首次下床时间和术后满意度。记录术后24 h内恶心呕吐、皮肤瘙痒、苏醒期躁动和呼吸抑制等不良反应发生情况，Q组记录腰方肌阻滞相关并发症的发生情况。结果:Q组切皮前、切皮后5 min,SBP、DBP 和HR的差值均明显小于C组(P＜0.05);Q组术后6、12 h VAS评分显著低于C组(P＜0.05)，术中瑞芬太尼用量显著少于C组(P＜0.05);镇痛泵首次按压时间显著晚于C组(P＜0.05);术后0~6 h、6~12 h 舒芬太尼用量明显少于C 组(P＜0.05);补救性镇痛发生率明显低于C 组(P＜0.05);术后首次下床活动时间明显早于C组(P＜0.05)，术后镇痛满意度明显高于C组(P＜0.05)。术后恶心呕吐、苏醒期躁动的发生率显著低于C组(P＜0.05)，皮肤瘙痒和呼吸抑制的发生率无显著差异(P＞0.05)，Q组未见腰方肌阻滞相关并发症。结论:腰方肌阻滞可显著降低老年患者后腹腔镜肾癌根治术阿片类药物的用量，增强术后镇痛效果，提高患者满意度。

The analgesia effect of quadratus lumborum block (QLB) in elderly patients undergoing laparoscopic radical nephrectomy

Objective:To evaluate the analgesia effect for quadratus lumborum block (QLB) in elderly patients undergoing laparoscopic radical nephrectomy.Methods:Sixty ASA I-Ⅲ patients,aged 65~76 years old scheduled for laparoscopic partial nephrectomy were divided into two groups(30 cases in each group) using a random number table:QLB group (group Q） and control group (group C）.After induction of general anesthesia,ultrasound guided QLB was performed on the operated side in group Q,and general anesthesia was performed in group C.Patient controlled intravenous analgesia (PCIA) was performed for all patients after surgery.Dezocine 5 mg was intravenously injected as a rescue analgesia to maintain visual analogue scale score （VAS）<6.The values of systolic pressure (SBP),diastolic pressure (DBP),heart rate (HR) immediately before and 5 minutes after skin incision were recorded.The dosage of remifentanil intraoperative,visual analogue scores (VAS) of 6,12 and 24 h after operation,the time for first pressing the analgesic pump button,the consumption of sufentanil,rescue analgesia,the time of getting out of bed,the patients' satisfaction score were recorded in the two groups.The incidence of PONV,pruritus,emergence agitation,and respiratory depression were recorded.QLB related complications were also recorded in group Q.Results:The changes of SBP,DBP and HR 5 min before and after skin incision in group Q was significantly lower than those in group C(P＜0.05).VAS scores 6,12 h postoperative were significantly lower than those in group C(P＜0.05).The usage of remifentanil during operation in group Q significantly decreased compared with that in group C (P<0.05).The first time pressing the analgesic pump button in group Q was significantly later than that in group C (P＜0.05).The usage of sufentanil significantly decreased in group Q at 6 and 12 h after operation compared with that in group C (P＜0.05).The times of rescue analgesia in group Q was lower than that in group C (P＜0.05).The time getting out of bed in group Q were significantly earlier compared with that in group C (P＜0.05).The patient's satisfaction score was significantly higher in group Q compared with that in group C (P＜0.05).The incidence of PONV and emergence agitation were lower in group Q than those in group C(P<0.05).The incidence of pruritus and respiratory depression was the same between two groups(P＞0.05).Conclusion:QLB reduces the perioperative opioid consumption，enhances the effect of analgesia and improves the patient's degree of satisfaction in eldly patients undergoing laparoscopic radical nephrectomy.