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| 布比卡因脂质体用于外侧弓状韧带上腰方肌阻滞对腹腔镜肾切除术患者术后恢复质量的影响 |
| Effect of liposomal bupivacaine for quadratus lumborum block at the lateral supra-arcuate ligament on quality of postoperative recovery in patients undergoing laparoscopic nephrectomy |
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| DOI：10.12089/jca.2026.06.006 |
| 中文关键词: 布比卡因脂质体 腰方肌阻滞 弓状韧带 恢复质量 肾切除术 |
| 英文关键词: Liposomal bupivacaine Quadratus lumborum block Supra-arcuate ligament Recovery quality Nephrectomy |
| 基金项目:徐州市卫生健康委科技项目（XWKYHT20230032） |
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| 中文摘要: |
目的：探究布比卡因脂质体用于外侧弓状韧带上腰方肌阻滞对腹腔镜肾切除术患者术后恢复质量的影响。
方法：选择择期全麻下行腹腔镜肾切除术患者，年龄18～74岁，BMI 18.5～30.0 kg/m2，ASA Ⅰ—Ⅲ级。采用随机数字表法将患者分为两组：布比卡因脂质体组（BL组）和布比卡因组（BH组）。麻醉诱导前行外侧弓状韧带上腰方肌阻滞，BL组注射布比卡因脂质体10 ml（133 mg）和生理盐水10 ml，BH组注射0.375%布比卡因20 ml。主要指标为术后24 h 15项恢复质量（QoR-15）评分。次要指标包括术后48 h QoR-15评分，术后24、48 h阿森斯失眠量表（AIS）评分，静息和活动时NRS疼痛评分累计曲线下面积（AUC），术后2、6、12、24、48 h静息和活动时NRS疼痛评分，术后24、48 h内吗啡当量总用量、术后首次按压镇痛泵时间、镇痛泵有效按压次数及总按压次数、术后首次下床活动时间、术后住院时间。
结果：共纳入患者96例，每组48例。与BH组比较，BL组术后24、48 h QoR-15评分明显升高、吗啡当量总用量明显减少、运动时NRS疼痛评分累计AUC明显减小，术后24 h AIS评分明显降低，术后首次按压镇痛泵时间明显延长，镇痛泵有效按压次数及总按压次数明显减少，术后首次下床活动时间与术后住院时间明显缩短（P<0.05）。
结论： 布比卡因脂质体用于外侧弓状韧带上腰方肌阻滞可提高腹腔镜肾切除术患者术后恢复质量。 |
| 英文摘要: |
Objective: To investigate the effect of liposomal bupivacaine for quadratus lumborum block at the lateral supra-arcuate ligament on the quality of postoperative recovery in patients undergoing laparoscopic nephrectomy.
Methods: Patients underwent elective laparoscopic nephrectomy under general anesthesia, aged 18-74 years, BMI 18.5-30.0 kg/m2, ASA physical status Ⅰ-Ⅲ, were selected and divided into two groups using the random number table method: liposomal bupivacaine group (group BL) and bupivacaine hydrochloride group (group BH). Before anesthetic induction, the quadratus lumborum block at the lateral supra-arcuate ligament was performed. Group BL received an injection of liposomal bupivacaine 10 ml (133 mg) plus normal saline 10 ml, while group BH received an injection of 0.375% bupivacaine hydrochloride 20 ml. The primary outcome was 15-item quality of recovery (QoR-15) score at 24 hours postoperatively, the secondary outcomes included QoR-15 scores at 48 hours postoperatively, Athens insomnia scale (AIS) scores, the area under the curve (AUC) of the cumulative NRS scores at rest and during activity, and total morphine equivalent consumption within 24 and 48 hours postoperatively, the numerical rating scale (NRS) pain scores at rest and during activity at 2, 6, 12, 24, and 48 hours postoperatively, time to first analgesic pump press, number of effective analgesic pump presses, and total number of analgesic pump presses, time to first ambulation, postoperative hospital stay duration.
Results: Ninety-six patients were included, 48 patients in each group. Compared with group BH, the QoR-15 scores were significantly increased at 24 and 48 hours postoperatively, total morphine equivalent consumption were significantly reduced at 24 and 48 hours postoperatively, and cumulative AUC of NRS pain scores during activity were significantly reduced at 24 and 48 hours postoperatively, AIS scores were significantly reduced at 24 hours postoperatively, the time to first analgesic pump press were significantly prolonged, the number of effective analgesic pump presses and total number of analgesic pump presses were significantly reduced, the time to first ambulation and postoperative hospital stay duration were significantly shortened in group BL (P < 0.05).
Conclusion: The use of liposomal bupivacaine for quadratus lumborum block at the lateral supra-arcuate ligament can improve the quality of postoperative recovery in patients undergoing laparoscopic nephrectomy. |
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