文章摘要
不同层面腰方肌阻滞对剖宫产产妇术后镇痛的影响
Effect of different levels of quadratus lumborum block on postoperative analgesia after cesarean section
  
DOI：10.12089/jca.2022.04.006
中文关键词: 腰方肌阻滞  剖宫产术  胸腰筋膜  神经阻滞  术后镇痛
英文关键词: Quadratus lumborum block  Cesarean section  Thoracolumbar fascia  Nerve block  Postoperative analgesia
基金项目:四川省医学青年创新科研课题（Q19001）
作者单位E-mail
潘雪琳 610011,成都市,四川锦欣妇女儿童医院麻醉科  
唐勇 610011,成都市,四川锦欣妇女儿童医院麻醉科 1960544843@qq.com 
李丹 610011,成都市,四川锦欣妇女儿童医院麻醉科  
李妮娟 610011,成都市,四川锦欣妇女儿童医院麻醉科  
钟杨 610011,成都市,四川锦欣妇女儿童医院麻醉科  
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中文摘要:
      
目的 探讨超声引导下前层胸腰筋膜下和前层胸腰筋膜外实施腰方肌阻滞（QLB）对剖宫产术后镇痛的影响。
方法 选择择期腰-硬联合麻醉下行剖宫产手术的产妇113例，年龄23～39岁，体重50～90 kg，ASA Ⅰ或Ⅱ级，孕期>37周。采用随机数字表法将产妇分为两组：前层胸腰筋膜下阻滞组（S组，n=57）和前层胸腰筋膜外阻滞组（E组，n=56）。所有产妇腰-硬联合麻醉用药相同，术毕连接患者自控静脉镇痛（PCIA）泵，S组术毕行超声引导下前层胸腰筋膜下阻滞，E组行超声引导下前层胸腰筋膜外阻滞。记录首次按压PCIA时间，术后24 h内PCIA有效按压次数以及布托啡诺用量。记录QLB实施后6、9、12、24、48 h静息和活动时VAS疼痛评分、BCS舒适度评分以及阻滞平面存在情况。记录头晕、恶心呕吐、肌力减退等不良反应发生情况。
结果 两组首次按压PCIA时间差异无统计学意义。S组术后24 h内PCIA有效按压次数、布托啡诺用量明显少于E组（P＜0.05）。QLB阻滞实施后不同时点静息和活动时VAS疼痛评分、BCS舒适度评分差异均无统计学意义。S组QLB实施后24 h阻滞平面存在的产妇比例明显高于E组（P＜0.05）。S组头晕发生率明显低于E组（P＜0.05）。
结论 超声引导下前层胸腰筋膜下实施腰方肌阻滞应用于剖宫产术后镇痛效果好，不良反应少，是剖宫产术后镇痛更适宜的阻滞层面。
英文摘要:
      
Objective To investigate the effect of quadratus lumborum block (QLB) under and outside the anterior thoracolumbar fascia guided by ultrasound on postoperative analgesia after cesarean section.
Methods A total of 113 pregnant women, aged 23-39 years, weighing 50-90 kg, ASA physical status Ⅰ or Ⅱ, pregnancy >37 weeks, underwent elective cesarean section under combined spinal epidural anesthesia were selected. They were randomly divided into two groups using the random number table method: the anterior thoracolumbar subfascial block group (group S, n = 57) and the anterior thoracolumbar extrafascial block group (group E, n = 56). The drugs for combined spinal epidural anesthesia were the same in all women, and the patient-controlled intravenous analgesia (PCIA) pump was connected at the end of the operation. Group S received ultrasound-guided anterior thoracolumbar subfascial block after operation, and group E received ultrasound-guided anterior thoracolumbar extrafascial block. The time of first pressing PCIA, the number of effective PCIA compression and the dosage of butorphanol within 24 hours after operation were recorded. The VAS score at rest and in activity and BCS comfort score and block level 6, 9, 12, 24, 48 hours after QLB were recorded. Adverse reactions such as dizzines, nausea, vomiting and muscle weakness were recorded.
Results There was no significant difference in the time of first pressing PCIA between the two groups. The effective times of pressing PCIA and the dosage of butorphanol within 24 hours after operation in group S were significantly less than those in group E (P < 0.05). There were no significant differences in VAS score and BCS comfort score at different time points after QLB. The number of pregnant women with block plane within 24 hours after QLB in group S was more than that in group E (P < 0.05). The incidence of dizziness in group S was significantly lower than that in group E (P < 0.05).
Conclusion Ultrasound-guided anterior thoracolumbar subfascial to implement quadratus lumborum block after cesarean section has good analgesic effect, less adverse reactions, which brings about a more suitable block level for postoperative analgesia after cesarean section.
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