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| 后路腰方肌阻滞联合帕瑞昔布钠在老年患者腹腔镜结直肠癌根治术中的应用 |
| Application of postoperative analgesia on posterior lumbar quadratus block combined with parecoxib sodium in elderly patients undergoing laparoscopic radical resection of colorectal cancer |
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| DOI：10.12089/jca.2022.02.008 |
| 中文关键词: 后路腰方肌阻滞 老年 帕瑞昔布 结直肠癌根治术 |
| 英文关键词: Posterior lumbar quadratus block Aged Parecoxib sodium Radical resection of colorectal cancer |
| 基金项目:安徽省马鞍山市科技计划项目（YL-2020-12,YL-2021-06） |
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| 中文摘要: |
目的 观察超声引导下后路腰方肌阻滞联合帕瑞昔布钠在老年患者腹腔镜结直肠癌根治术中的应用。
方法 选择2017年3月至2020年12月腹腔镜结直肠癌根治术的老年患者90例，男54例，女36例，年龄65～85岁，BMI 21～29 kg/m2，ASA Ⅰ—Ⅲ级。采用随机数字表法将患者分为三组：帕瑞昔布钠组（P组）、后路腰方肌阻滞组（Q组）和后路腰方肌阻滞联合帕瑞昔布钠组（QP组），每组30例。所有患者静脉全麻用药方案一致。P组术毕每12小时静注帕瑞昔布钠40 mg，共4次；Q组术毕在超声引导下予0.35%罗哌卡因行双侧后路腰方肌阻滞，单侧20 ml；QP组在超声引导下予0.35%罗哌卡因行双侧后路腰方肌阻滞，单侧20 ml，后每12小时静注帕瑞昔布钠40 mg，共4次。记录苏醒即刻（t0）躁动评分。记录t0、出恢复室即刻（t1）、术后2 h（t2）、6 h（t3）、12 h（t4）、24 h（t5）、48 h（t6）静息时VAS疼痛评分和t1—t6时Prince-Henry评分。记录术后24 h内阿片类药物补救镇痛例数、术后首次下床活动时间、患者满意情况、术后恶心、呕吐及皮肤瘙痒发生情况。
结果 与P组比较，Q组t0时躁动评分、t0—t3时静息时VAS疼痛评分、t1—t3时Prince-Henry评分明显降低（P<0.05），术后首次下床活动时间明显缩短（P<0.05）；QP组t0时躁动评分、t0—t4及t6时静息时VAS疼痛评分、t1—t6时Prince-Henry评分明显降低（P<0.05），阿片类镇痛药物补救镇痛率、术后恶心发生率明显降低（P<0.05），术后首次下床活动时间明显缩短（P<0.05），患者满意率明显升高（P<0.05）。与Q组比较，t1—t6时QP组静息时VAS疼痛评分和Prince-Henry评分均明显降低（P<0.05），术后首次下床活动时间明显缩短（P<0.05）。
结论 超声引导下后路腰方肌阻滞联合帕瑞昔布钠镇痛可以减轻老年患者腹腔镜结直肠癌根治术后疼痛，满足老年患者术后镇痛需要，减少阿片类药物的使用，减少术后不良反应，提高患者满意率。 |
| 英文摘要: |
Objective To observe the application of postoperative analgesia on ultrasound-guided posterior lumbar quadratus block combined with non-steroidal analgesic parecoxib sodium in elderly patients undergoing laparoscopic radical resection of colorectal cancer.
Methods Ninety patients from March 2017 to December 2020, 54 males and 36 females, aged 65-85 years, BMI 21-29 kg/m2, ASA physical stasus Ⅰ-Ⅲ, undergoing elective laparoscopic colorectal surgery, were randomly divided into three groups using random number table method: parecoxib sodium group (group P), posterior lumbar quadratus block group (group Q), and posterior lumbar quadratus block group combined with parecoxib sodium group (group QP), 30 patients in each group. Routine anesthesia was performed during the perioperative period, followed by administration of parecoxib sodium (40 mg, every 12 hours, four times in total) in group P; 0.35% ropivacaine was administered through bilateral posterior lumbar quadratus block, 20 ml for each side after surgery in group Q; 0.35% ropivacaine was administered through bilateral posterior lumbar quadratus block, 20 ml for each side after surgery, combined with parecoxib sodium (40 mg, every 12 hours, four times in total) in group QP. The score of patients' awakening and immediate agitation, VAS scores at rest at awakening (t0), 1 hour (t1), 2 hours (t2), 6 hours (t3), 12 hours (t4), 24 hours (t5) and 48 hours (t6) after operation were recorded, respectively. The Prince-Henry score at t1-t6, the number of opioid remedy analgesia, the time of first getting out of bed, the overall satisfaction rate with analgesia and the occurrence of adverse reactions such as postoperative nausea, vomiting and skin pruritus within 24 hours after operation were recorded.
Results Compared with group P, the agitation score at t0, the VAS scores at rest at t0-t3, the Prince-Henry score at t1-t3 in group Q were significantly decreased (P < 0.05), the first ambulation time was significantly shortened in group Q (P < 0.05); the agitation score at t0, the VAS scores at rest at t0-t4 and t6, the Prince-Henry score at t1-t6 in group QP were significantly decreased (P < 0.05), the incidence of opioid analgesics and postoperative nausea in group QP were significantly decreased (P < 0.05), the first ambulation time was significantly shortened in group QP (P < 0.05), the postoperative overall satisfaction rate was significantly increased in group QP (P < 0.05). Compared with group Q, the VAS scores at rest and the Prince-Henry score at t1-t6 in group QP were significantly decreased (P < 0.05), the first ambulation time was significantly shortened in group QP (P < 0.05).
Conclusion Ultrasound-guided posterior lumbar quadratus block combined with non-steroidal analgesic parecoxib sodium can improve postoperative overall satisfaction rate for the surgery, effectively relieve postoperative pain induced by laparoscopic colorectal surgery for cancer, and consequently reduces the use of opioids． |
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