目的 探究超声引导双侧腰方肌前路阻滞（quadratus lumborum block,QLB）用于全麻下开放性卵巢癌根治术镇痛对阿片类药物用量、术后恢复及舒适度的影响。方法 回顾性选取80例2023年11月—2024年12月于我院行卵巢癌根治术的卵巢癌患者资料,对其临床治疗进行分析,将其中40例行常规全麻（general anesthesia,GA）的患者作为对照组,40例行双侧前路QLB+GA的患者作为观察组,患者术后均接受自控静脉镇痛（patient-controlled intravenous analgesia,PCIA）。比较两组患者PCIA使用情况、术后4、8、12、24 h镇痛效果、围术期相关指标、手术前后炎症因子[C反应蛋白（C-reactive protein,CRP）、白细胞介素（interleukin,IL）-6、IL-8],记录术后不良反应情况。结果 相比对照组,观察组PCIA次数更少,术后苏醒、拔管以及至首次排气用时较短,术中及术后舒芬太尼使用量更低,手术有效镇痛时间更长;术后4、8、12、24 h四个时间段内,观察组VAS评分均低于对照组;术后,两组患者的CRP、IL-6及IL-8水平均较术前显著升高,但观察组CRP、IL-6及IL-8水平低于对照组。两组总不良反应率无统计学差异。结论 双侧前路QLB用于全麻下开放性卵巢根治术有良好的镇痛效果,可降低阿片类药物剂量,并有助于改善炎症应激反应,促进患者更快地恢复,且安全性良好。
Abstract
Objective To explore the analgesic effect of ultrasound-guided bilateral anterior quadratus lumborum block (QLB) and its influences on opioid dosage, postoperative recovery and comfort in open radical operation of ovarian cancer under general anesthesia. Methods A retrospective collection was performed on the data from 80 patients with ovarian cancer who underwent radical surgery in the hospital between November 2023 and December 2024. According to different clinical treatment methods, they were divided into control group[40 cases, routine general anesthesia (GA) ]and observation group (40 cases, bilateral anterior QLB+GA). After surgery, all patients were given patient-controlled intravenous analgesia (PCIA). PCIA use, analgesic effect at 4h, 8h, 12h and 24h after surgery, perioperative indexes and inflammatory factors [C-reactive protein (CRP), interleukin-6(IL-6), interleukin-8(IL-8)] before and after surgery were compared between the two groups, and postoperative adverse reactions were recorded. Results Compared with control group, PCIA frequency was lower, postoperative recovery time, extubation time and the first exhaust time were shorter, intraoperative and postoperative dosages of sufentanil were lower, and effective analgesia time was longer in observation group. At 4h, 8h, 12h and 24h after surgery, VAS scores in observation group were lower than those in control group . After surgery, levels of CRP, IL-6 and IL-8 was significantly increased in both groups, which were lower in observation group than control group. The difference in total incidence of adverse reactions between the two groups was not statistically significant. Conclusion The analgesic effect of bilateral anterior QLB is good in open radical operation of ovarian cancer under general anesthesia, which can reduce opioid dosage, relieve inflammatory stress response and promote faster postoperative recovery, with good safety.
关键词
超声引导双侧腰方肌前路阻滞 /
全身麻醉 /
开放性卵巢癌根治术 /
阿片类药物 /
镇痛
Key words
ultrasound-guided bilateral anterior quadratus lumborum block /
general anesthesia /
open radical operation of ovarian cancer /
opioid /
analgesia
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基金
浙江省自然科学计划项目 “基于糖代谢重编程探讨裘氏宫颈方调控TKTL1/NOX4/HIF-1α轴干预宫颈癌的作用机制”（LMS25H270003）
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