超声引导下腰方肌阻滞用于腹腔镜结直肠手术围手术期的麻醉效果及对术后睡眠质量的影响

Perioperative anesthetic effect of ultrasound-guided quadratus lumborum block and its impact on postoperative sleep quality in patients undergoing laparoscopic colorectal surgery

摘要:

目的 探讨超声引导下腰方肌阻滞（QLB）用于腹腔镜结直肠手术围手术期的麻醉效果及对术后睡眠质量的影响。方法 选取2019年1月—2022年1月在淮安八十二医院择期行腹腔镜结直肠手术的80例患者，抽签随机分为观察组和对照组，每组40例。在超声引导下对照组行腹横筋膜阻滞（TAPB），观察组行双侧QLB。比较两组患者围手术期指标、收缩压（SBP）、舒张压（DBP）、心率（HR）、睡眠质量［主观睡眠质量评分、24 h内镇痛泵总消耗量、视觉模拟评分（VAS）、免疫功能（CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺）和不良反应及术后止痛药物应用情况。结果 观察组瑞芬太尼用量、术后首次排气和排便时间均低于对照组（P <0.05）。观察组与对照组T₀、T₁、T₂、T₃的SBP、DBP、HR水平比较，结果 ①不同时间点SBP、DBP、HR水平比较，差异均有统计学意义（F =22.396、15.403和7.676，均P =0.000）；②观察组与对照组SBP、DBP、HR水平比较，差异均有统计学意义（F =44.528、21.176和21.683，均P =0.000）；③两组SBP、DBP、HR变化趋势比较，差异均有统计学意义（F =38.764、19.075和12.840，均P =0.000）。观察组主观睡眠质量评分高于对照组（P <0.05）。观察组24 h内镇痛泵总消耗量小于对照组（P <0.05）。观察组与对照组术后1、6、12、24 h的静息、活动状态下VAS评分比较，结果 ①不同时间点静息、活动状态下VAS评分比较，差异均有统计学意义（F =14.635和20.754，均P =0.000）；②观察组与对照组静息、活动状态下VAS评分比较，差异均有统计学意义（F =48.432和51.267，均P =0.000）；③两组静息、活动状态下VAS评分变化趋势比较，差异均有统计学意义（F =18.416和22.763，均P =0.000）。观察组术后CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺的下降程度小于对照组（P <0.05）。观察组不良反应总发生率、术后止痛药应用率均低于对照组（P <0.05）。结论 超声引导下QLB用于腹腔镜结直肠手术患者，可有效减轻术后疼痛，改善术后睡眠质量，且安全性较高。

Abstract:

Objective To explore the anesthetic effect of ultrasound-guided quadratus lumborum block (QLB) during the perioperative period of laparoscopic colorectal surgery and its impact on postoperative sleep quality.Methods Eighty patients who underwent laparoscopic colorectal surgery in Huai'an 82nd Hospital from January 2019 to January 2022 were selected and divided into an observation group and a control group by a random draw, with 40 patients in each group. Under ultrasound guidance, the control group underwent transversus abdominis plane block (TAPB), while the observation group underwent bilateral QLB. Perioperative indicators, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), sleep quality assessed via the subjective sleep quality score, total consumption of analgesics via the pump system within 24 hours, the Visual Analogue Scale (VAS) score, immune function (frequency of CD3⁺, CD4⁺, CD8⁺, and CD4⁺/CD8⁺ cells), adverse reactions, and postoperative use of painkillers were compared between the two groups.Results The dosage of remifentanil was lower, and the time to first flatus and defecation was shorter in the observation group compared with those in the control group (P < 0.05). The SBP, DBP, and HR at T₀, T₁, T₂, and T₃ were compared between the observation group and the control group. The results showed that there were statistically significant differences in SBP, DBP, and HR among different time points (F = 22.396, 15.403, and 7.676, all P = 0.000) and between the observation group and the control group (F = 44.528, 21.176, and 21.683, all P = 0.000), and that the change trends of SBP, DBP, and HR were different between the observation group and the control group (F = 38.764, 19.075, and 12.840, all P = 0.000). The subjective sleep quality score of the observation group was higher than that of the control group (P < 0.05). The total consumption of analgesics via the pump system within 24 hours in the observation group was lower than that in the control group (P < 0.05). Comparison of VAS scores measured at rest and during activity between the observation group and the control group at 1 hour, 6 hours, 12 hours, and 24 hours after surgery revealed that there were differences in VAS scores measured at rest and during activity among different time points (F =14.635 and 20.754, both P =0.000) and between the observation group and the control group (F = 48.432 and 51.267, both P = 0.000), and that the change trends of VAS scores measured at rest and during activity were also different between the observation group and the control group (F = 18.416 and 22.763, both P = 0.000). The decreases in frequency of CD3⁺, CD4⁺, CD8⁺, and CD4⁺/CD8⁺ cells after surgery in the observation group were lower than those in the control group (P < 0.05). The incidence of adverse reactions and the rate of postoperative use of painkillers in the observation group were lower than those in the control group (P < 0.05).Conclusions Ultrasound-guided QLB effectively alleviates postoperative pain and improves postoperative sleep quality in patients undergoing laparoscopic colorectal surgery with a high safety profile.