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超声引导下腰方肌阻滞可减少腹腔镜肾部分切除手术患者术后阿片类镇痛药物的用量
- Affiliations：
1. 1Anesthesiology Department, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
2. 2Central Research Laboratory, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
3. 3Urology Department, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
- Author bio：
* Tel: 86-10-69152030; Fax: 86-10-69152020; E-mail: garybeijing@163.com.
- Funds：
DOI：10.24920/003759
中图分类号：收稿日期：2020-04-20，
录用日期：2020-6-29，
网络出版日期：2020-12-31，
纸质出版日期：2020-12-31
- Accepted：
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崔旭蕾, 李旭, 李敏娜, 等. 超声引导下腰方肌阻滞可减少腹腔镜肾部分切除手术患者术后阿片类镇痛药物的用量[J]. 中国医学科学杂志（英文版）, 2020,35(4):289-296.
Cui Xulei, Li Xu, Li Minna, et al. Ultrasound-Guided Transmuscular Quadratus Lumbar Block Reduces Opioid Consumption after Laparoscopic Partial Nephrectomy[J]. Chinese medical sciences journal, 2020, 35(4): 289-296.
崔旭蕾, 李旭, 李敏娜, 等. 超声引导下腰方肌阻滞可减少腹腔镜肾部分切除手术患者术后阿片类镇痛药物的用量[J]. 中国医学科学杂志（英文版）, 2020,35(4):289-296. DOI： 10.24920/003759.
Cui Xulei, Li Xu, Li Minna, et al. Ultrasound-Guided Transmuscular Quadratus Lumbar Block Reduces Opioid Consumption after Laparoscopic Partial Nephrectomy[J]. Chinese medical sciences journal, 2020, 35(4): 289-296. DOI： 10.24920/003759.
摘要
目的
经腰方肌阻滞（transmuscular quadratus lumborum block
TQLB）可为腹膜内手术患者提供术后镇痛。本研究目的是检验TQLB在进行腹膜后手术如肾部分切除术（laparoscopic partial nephrectomy
LPN）的患者中的潜在疗效。
方法
本前瞻性随机对照研究于2017年8月至2018年11月在北京协和医院进行。选择18-70岁、ASA身体状况评分为I-II并准备进行LPN的患者为研究对象
随机分为TQLB组（给予0.6mL/kg 0.5%罗哌卡因加全麻）或对照组（单纯全麻）。术后立即开始吗啡静脉自控镇痛。主要结局指标为术后8小时内吗啡的累积消耗量
次要结局指标包括术后其他时间点吗啡的消耗量、休息时和活动期间的疼痛评分、术后恶心呕吐（postoperative nausea and vomitting
PONV）发生率
以及其他与患者恢复相关的指标。
结果
TQLB组和对照组分别招募到30例患者。TQLB组术后8小时吗啡累积消耗量显著低于对照组（中位数
0.023 mg/kg vs. 0.068 mg/kg
U
=207.5
P
<
0.001）。两组术后疼痛评分无显著性差异。TQLB组术后24小时PONV发生率低于对照组（20% vs. 47%
χ
2
=4.8
P
=0.028）
术后120小时平均康复质量评分高于对照组（138.6 vs. 131.9
t
=-2.164
P
=0.035）。
结论
TQLB可在LPN术后早期起到减少阿片类药物用量的作用
同时降低PONV的发生率
提高患者的康复质量。
Abstract
Objectives
Transmuscular quadratus lumborum block (TQLB) may provide postoperative analgesia in patients undergoing intraperitoneal surgeries. The purpose of this study was to examine the potential efficacy of TQLB among patients undergoing retroperitoneal procedures
such as the laparoscopic partial nephrectomy (LPN).
Methods
This prospective
randomized
controlled study was conducted from August 2017 to November 2018 at Peking Union Medical College Hospital (Beijing
China). Patients who were scheduled for a LPN
aged 18-70 years old with an ASA physical status score of I - II were randomly assigned to receive either TQLB with 0.6 ml/kg of 0.5% ropivacaine plus general anesthesia (TQLB group) or general anesthesia alone (control group). Patient-controlled intravenous analgesia with morphine was initiated immediately upon surgery completion. The primary outcome was the cumulative consumption of morphine within 8 h after surgery. The secondary outcome included postoperative consumptions of morphine at other time points
pain score at rest and during activity
postoperative nausea and vomitting (PONV)
and recovery related parameters.
Results
Totally 30 patients per group were recruited in the study. The 8 h consumption of morphine was lower in the TQLB group than in the control group (median
0.023 mg/kg
vs
. 0.068 mg/kg
U=207.5
P
<
0.001). No significant differences were observed in postoperative pain scores between the two groups. Patients in the TQLB group had fewer episodes of PONV (20%
vs.
47%
χ
2
=4.8
P
=0.028) in the first 24 h after surgery and higher scores for quality of recovery (mean
138.6
vs.
131.9
t
=-2.164
P
=0.035) 120 h after surgery than the controls.
Conclusions
TQLB resulted in an opioid-sparing effect during the early postoperative period following LPN
as well as a lower incidence of PONV and improved quality of recovery.
关键词
Keywords
references
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