文章摘要
前路腰方肌阻滞对肾移植患者术后急慢性疼痛的影响
Effects of anterior quadratus lumborum block on postoperative acute and chronic pain in patients undergoing kidney transplantation
  
DOI：10.12089/jca.2025.07.006
中文关键词: 腰方肌阻滞  肾移植  急性疼痛  慢性疼痛
英文关键词: Quadratus lumborum block  Kidney transplantation  Acute pain  Chronic pain
基金项目:国家自然科学基金面上项目（62376168）；北京市医院管理中心“培育计划”（PX2022033）
作者单位E-mail
安奕 100053,首都医科大学宣武医院麻醉手术科  
李丽霞 100053,首都医科大学宣武医院麻醉手术科  
李中嘉 100053,首都医科大学宣武医院麻醉手术科  
梁传玉 100053,首都医科大学宣武医院麻醉手术科  
王沛 100053,首都医科大学宣武医院麻醉手术科  
贾雪菲 100053,首都医科大学宣武医院麻醉手术科  
宋宏怡 100053,首都医科大学宣武医院麻醉手术科  
崔珂 100053,首都医科大学宣武医院麻醉手术科  
罗荟方 100053,首都医科大学宣武医院麻醉手术科  
王天龙 100053,首都医科大学宣武医院麻醉手术科  
赵磊 100053,首都医科大学宣武医院麻醉手术科 zhaoalei@sina.com 
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中文摘要:
      
目的：探讨前路腰方肌阻滞（QLB）对肾移植患者术后急性和慢性疼痛的影响。
方法：选择2021年3—7月行同种异体肾移植术患者52例，男33例，女19例，年龄18～64岁，BMI 18.5～32.0 kg/m2，ASA Ⅰ—Ⅲ级。采用随机数字表法将患者分为两组：腰方肌阻滞组（Q组）和对照组（C组），每组26例。Q组在麻醉诱导前接受前路QLB，C组于术毕接受切口局部浸润麻醉，使用药物均为0.5%罗哌卡因30 ml。记录术中丙泊酚和瑞芬太尼用量、手术时间、麻醉时间。记录手术结束即刻、术后2、4、6、8、12、24、48 h静息和活动时NRS疼痛评分，评估术后4 h内中重度疼痛（NRS疼痛评分≥4分）的发生情况。记录补救镇痛例数、首次补救镇痛时间、术后首次肛门排气时间、术后首次饮水时间和术后住院时间。电话随访术后3、6个月术后慢性疼痛（CPSP）的发生情况。
结果：与C组比较，Q组术中丙泊酚和瑞芬太尼用量明显减少（P＜0.05），手术时间和麻醉时间明显延长（P＜0.05）；手术结束即刻、术后2、4、6、8、12 h静息和活动时NRS疼痛评分明显降低（P＜0.05），术后4 h内中重度疼痛发生率明显降低（P＜0.05）；术后补救镇痛率明显降低（P<0.05）。两组首次补救镇痛时间、术后首次肛门排气时间、术后首次饮水时间、术后住院时间以及术后3、6个月CPSP发生率差异无统计学意义。
结论：前路QLB可显著缓解肾移植患者术后短期内患者活动时手术部位疼痛，镇痛效果可延长至术后12 h，不影响术后3、6个月慢性疼痛发生率。
英文摘要:
      
Objective: To evaluate the effects of anterior quadratus lumborum block (QLB) on postoperative acute and chronic pain in patients undergoing kidney transplantation.
Methods: Fifty-two patients who were selected to undergo allograft kidney transplantation surgery from March 2021 to July 2021, 33 males and 19 females, aged 18-64 years, BMI 18.5-32.0 kg/m2, ASA physical statusⅠ-Ⅲ, were included in this study. The patients were divided into two groups according to the random number table: QLB group (group Q) and control group (group C), 26 patients in each group. The patients in group Q received ultrasound guided QLB before general anesthesia induction, and the patients in group C received local infiltration anesthesia, all of which were performed with 0.5% ropivacaine 30 ml. The intraoperative dosage of propofol and remifentanil, operation time, and anesthesia time were recorded. Numerical pain scores (NRS) at rest and during activity immediately at the end of the surgery, 2, 4, 6, 8, 12, 24, and 48 hours after surgery were recorded, and the occurrence of moderate to severe pain (NRS pain score ≥ 4 points) within 4 hours after the surgery was evaluated. The number of remedial analgesia, the time of first remedial analgesia, the first postoperative flatus time, the first postoperative drinking time, and the length of stay after surgery were recorded. The incidence of chronic postsurgical pain (CPSP) 3 and 6 months after the surgery were investigated with telephone follow-up.
Results: Compared with group C, the dosages of propofol and remifentanil during the operation were significantly reduced, and the operation time and anesthesia time were significantly prolonged in group Q (P < 0.05). Compared with group C, the NRS scores at rest and during activity immediately at the end of the surgery, 2, 4, 6, 8, and 12 hours after the surgery was significantly decreased (P < 0.05), and the incidence of moderate and severe pain within 4 hours after the surgery was significantly decreased in group Q (P < 0.05). The proportion of remedial analgesia in group Q was significantly lower than that in group C (P < 0.05). There were no statistically significant difference in the time of first remedial analgesia, the first postoperative flatus time, the first drinking time, the postoperative hospital stay, and the incidence of CPSP 3 and 6 months after the surgery between the two groups.
Conclusion: Ultrasound-guided anterior QLB can significantly relieve acute pain in the short term after surgery, and the analgesic effect can be extended to 12 hours after the surgery, without affecting the incidence of chronic pain 3 and 6 months after the surgery.
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