腰方肌区域神经阻滞联合全身麻醉在老年妇科腹腔镜手术患者中的应用

doi:10.3760/cma.j.cn441417-20241021-10004

国际医药卫生导报 ›› 2025, Vol. 31 ›› Issue (10): 1604-1609.DOI: 10.3760/cma.j.cn441417-20241021-10004

腰方肌区域神经阻滞联合全身麻醉在老年妇科腹腔镜手术患者中的应用

邓小英¹ 梁皓² 温柔³ 张永刚¹

¹宝鸡市妇幼保健院麻醉科，宝鸡 721000；²宝鸡市陈仓区医院麻醉科，宝鸡 721000；³陕西中医药大学附属医院麻醉科，咸阳 712046

收稿日期:2024-10-21 出版日期:2025-05-15 发布日期:2025-05-21
通讯作者: 张永刚，Email：18992781200@163.com
基金资助:
陕西省重点研发计划（2022SF-585）

Quadratus lumborum block combined with general anesthesia for elderly patients undergoing gynecologic laparoscopic surgery

Deng Xiaoying¹, Liang Hao², Wen Rou³, Zhang Yonggang¹

¹Department of Anesthesiology, Baoji Maternal and Child Health Hospital, Baoji 721000, China; ²Department of Anesthesiology, Baoji Chencang Hospital, Baoji 721000, China; ³Department of Anesthesiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang 712046, China

Received:2024-10-21 Online:2025-05-15 Published:2025-05-21
Contact: Zhang Yonggang, Email: 18992781200@163.com
Supported by:
Key Plan of Research and Development in Shaanxi (2022SF-585)

摘要/Abstract

摘要：

目的　探讨腰方肌区域神经阻滞联合全身麻醉在老年妇科腹腔镜手术患者中的应用效果。方法　本研究为前瞻性、随机对照研究，选取2021年1月至2023年1月在宝鸡市妇幼保健院接受妇科腹腔镜手术的老年患者共96例，随机数字表法分为对照组与观察组。对照组48例，年龄（70.86±7.63）岁；观察组48例，年龄（71.14±7.87）岁。两组均行全身麻醉，观察组在麻醉诱导前30 min接受腰方肌区域神经阻滞。比较两组患者围手术期指标（瑞芬太尼用量、丙泊酚用量、苏醒时间、自主呼吸恢复时间），记录患者麻醉诱导前（T0）、插管后5 min（T1）、切皮时（T2）、术毕（T3）的心率和平均动脉压；对比术后1、24 h的疼痛评分、舒适度评分（BCS），术前、术后24 h的应激指标；分别在术前与术后1、3、7 d通过简易智能量表（MMSE）评估患者的认知功能，记录认知障碍发生率和不良反应发生率。采用t检验、重复测量方差分析、χ2检验进行统计比较。结果　对照组患者瑞芬太尼与丙泊酚用量、苏醒时间、自主呼吸恢复时间分别为（1.35±0.31）mg、（410.25±43.12）mg、（6.49±1.23）min、（15.07±2.43）min，观察组分别为（0.72±0.21）mg、（326.78±37.69）mg、（4.06±0.81）min、（9.55±1.62）min，且观察组术中心率和平均动脉压较对照组平稳，差异均有统计学意义（均P<0.05）；观察组与对照组术后疼痛评分［（3.54±0.40）分比（4.13±0.43）分］、BCS评分［（2.78±0.40）分比（2.03±0.38）分］比较，差异均有统计学意义（均P<0.05）；观察组术后24 h的应激指标低于对照组，术后不同时间点的MMSE评分均高于对照组，差异均有统计学意义（均P<0.05）；观察组认知障碍和不良反应发生率分别为2.08%（1/48）、6.25%（3/48），对照组分别为14.58%（7/48）、18.75%（9/48），差异均有统计学意义（均P<0.05）。结论　腰方肌区域神经阻滞联合全身麻醉有助于维持老年妇科腹腔镜手术患者血流动力学稳定，并降低术后认知功能障碍和不良反应风险。

关键词: 全身麻醉； , , 腰方肌区域神经阻滞； , , 老年； , , 妇科腹腔镜手术； , , 认知功能障碍

Abstract:

Objective　To explore the effect of quadratus lumborum block combined with general anesthesia for elderly patients undergoing gynecological laparoscopic surgery. Methods　Ninety-six elderly patients who underwent gynecological laparoscopic surgery at Baoji Maternal and Child Health Hospital from January 2021 to January 2023 were selected for the randomized controlled trial, and were divided into a control group who were (70.86±7.63) years old and an observation group who were (71.14±7.87) years old by the random number table method, with 48 cases in each group. Both groups received general anesthesia during the surgery; the observation group took quadratus lumborum block 30 min before anesthesia induction. The perioperative parameters (remifentanil and propofol dosages, awakening time, and time to recovery of spontaneous breathing) were compared between the two groups. The heart rate and mean arterial pressure were recorded before induction (T0), 5 min after intubation (T1), at skin incision (T2), and after the surgery (T3). The pain scores and comfort scores (BCS) 1 and 24 h after the surgery and the stress indicators before and 24 h after the surgery were compared between the two groups. Before and 1, 3, and 7 d after the surgery, their cognitive function was assessed using the Mini-Mental State Examination (MMSE). The incidence rates of cognitive impairment and adverse reactions were recorded. t test, repeated measurement analysis of variatment, and χ² were used for the statistical comparisons. Results　The dosages of remifentanil and propofol, awakening time, and time to recovery of spontaneous breathing in the control group were (1.35±0.31) mg, (410.25±43.12) mg, (6.49±1.23) min, and (15.07±2.43) min, and those in the observation group (0.72±0.21) mg, (326.78±37.69) mg, (4.06±0.81) min, and (9.55±1.62) min; the intraoperative heart rate and mean arterial pressure in the observation group were more stable than those in the control group; there were statistical differences (all P<0.05). There were statistical differences in the postoperative scores of pain and BCS between the observation group and the control group were (3.54±0.40 vs. 4.13±0.43 and 2.78±0.40 vs. 2.03±0.38), with statistical differences (all P<0.05). The observation group had lower postoperative stress markers and a higher MMSE score than the control group, with statistical differences (all P<0.05). The incidence rates of cognitive impairment and adverse reactions in the observation group were lower than those in the control group [2.08% (1/48) vs. 14.58% (7/48) and 6.25% (3/48) vs. 18.75%(9/48); both P<0.05]. Conclusion Quadratus lumborum block combined with general anesthesia can maintain hemodynamic stable in elderly patients undergoing gynecological laparoscopic surgery and reduce the risk of postoperative cognitive dysfunction and adverse reactions.

Key words: General anesthesia, Quadratus lumborum regional nerve block, Ederly patients, Gnecological laparoscopic surgery, Cognitive dysfunction

邓小英梁皓温柔张永刚. 腰方肌区域神经阻滞联合全身麻醉在老年妇科腹腔镜手术患者中的应用 [J]. 国际医药卫生导报, 2025, 31(10): 1604-1609.

Deng Xiaoying, Liang Hao, Wen Rou, Zhang Yonggang.

Quadratus lumborum block combined with general anesthesia for elderly patients undergoing gynecologic laparoscopic surgery [J]. International Medicine and Health Guidance News, 2025, 31(10): 1604-1609.

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腰方肌区域神经阻滞联合全身麻醉在老年妇科腹腔镜手术患者中的应用

Quadratus lumborum block combined with general anesthesia for elderly patients undergoing gynecologic laparoscopic surgery

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