超声引导下腰方肌阻滞对肾移植受体术后早期转归的影响

doi:10.20047/j.issn1673-7210.2023.31.24

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摘要目的探讨超声引导下腰方肌阻滞对肾移植术后早期转归的影响。方法选择中国人民解放军联勤保障部队第九二四医院于2021年1月至2023年1月择期行肾移植术的终末期肾病患者60例，按照随机数字表法将其分为腰方肌阻滞组（Q组）和腹横肌平面阻滞组（T组），各30例。麻醉诱导成功后Q组在超声引导下行腰方肌阻滞，T组在超声引导下行腹横肌平面阻滞。比较两组切皮前即刻和切皮后5 min心率（HR）和平均动脉压（MAP）；比较两组术中舒芬太尼和瑞芬太尼使用剂量；比较两组术后恢复指标情况；比较两组拔管15 min、术后2 h、术后12 h、术后24 h和术后48 h视觉模拟评分法（VAS）评分；比较两组术后镇痛期间并发症、有效按压次数和补救镇痛情况；比较两组麻醉前和术后48 h应激炎症反应变化。结果两组切片前即刻、切皮后5 min的HR和MAP组内、组间比较，差异无统计学意义（P＞0.05）。Q组术中舒芬太尼和瑞芬太尼使用剂量少于T组，差异有统计学意义（P＜0.05）。Q组术后复苏拔管时间、首次下床时间、住院时间短于T组，差异有统计学意义（P＜0.05）。整体分析发现：两组VAS评分组间、时间、交互作用比较，差异有统计学意义（P＜0.05）。组内比较：两组术后2、12、24、48 h的VAS评分高于拔管15 min；两组术后12、24、48 h的VAS评分高于术后2 h；两组术后24、48 h的VAS评分高于术后12 h；两组术后48 h的VAS评分低于术后24 h，差异有统计学意义（P＜0.05）。组间比较：Q组术后2、12、24、48 h的VAS评分低于T组，差异有统计学意义（P＜0.05）。两组术后镇痛期间并发症总发生率、补救镇痛率比较，差异无统计学意义（P＞0.05）。Q组有效按压次数少于T组，差异有统计学意义（P＜0.05）。术后48 h，两组皮质醇、C反应蛋白、白细胞介素-6和肿瘤坏死因子-α水平高于麻醉前，且Q组低于T组，差异有统计学意义（P＜0.05）。结论超声引导下腰方肌阻滞可加快肾移植术后早期恢复，术后镇痛效果显著，且对应激炎症反应影响小。

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	周汝虹　　杨旭亮　　何爱梅　　李洪

关键词 ：超声引导, 腰方肌阻滞, 肾移植术, 早期转归

Abstract：Objective To investigate the effect of ultrasound-guided quadratus lumbois block on early outcome of renal transplantation. Methods Sixty patients with end-stage renal disease who underwent kidney transplantation at the 924th Hospital of the Joint Logistics Support Force of the People’s Liberation Army of China from January 2021 to January 2023 were selected, according to the random number table method, they were divided into quadratus lumbois block group (group Q) and transversal muscle plane block group (group T), with 30 patients in each group. After successful induction of anesthesia, group Q was subjected to ultrasound-guided quadratus lumbois, group T was subjected to ultrasound-guided transversal muscle plane block. Heart rate (HR) and mean arterial pressure (MAP) were compared immediately before skin incision and five minutes after skin incision; the intraoperative doses of Sufentanil and Remifentanil were compared between two groups; the postoperative recovery indexes of two groups were compared; visual analog scale (VAS) score was compared between two groups extubation for 15 min, 2 h after surgery, 12 h after surgery, 24 h after surgery, and 48 h after surgery; complications during postoperative analgesia, effective compression times, and remedial analgesia were compared between two groups; the changes of stress inflammatory response before anesthesia and 48 h after surgery were compared between two groups. Results There were no statistically significant difference in HR and MAP intra-group and inter-group comparison between two groups immediately before skin incision and five minutes after skin incision (P＞0.05). The intraoperative doses of Sufentanil and Remifentanil of group Q were lower than those of group T, and the differences were statistically significant (P＜0.05). The postoperative resuscitation and extubation time, first time out of bed, and hospitalization time of group Q were shorter than those of group T, and the differences were statistically significant (P＜0.05). The overall analysis showed that there were statistically significant differences in the inter-group, time, and interaction of VAS between two groups (P＜0.05). Intra-group comparison: VAS scores at 2, 12, 24 h, and 48 h after surgery in both groups were higher than those at extubation of 15 min; VAS scores at 12, 24 h, and 48 h after surgery in both groups were higher than those at 2 h after surgery; VAS scores at 24 h and 48 h after surgery in both groups were higher than those at 12 h after surgery; VAS scores at 48 h after surgery in both groups were lower than those at 24 h after surgery, and the differences were statistically significant (P＜0.05). Comparison between groups: VAS scores of group Q at 2, 12, 24 h, and 48 h after surgery were lower than those of group T, and the differences were statistically significant (P＜0.05). There were no significant differences in the total incidence of complications and the rate of remedial analgesia between two groups (P＞0.05). The effective compression times of group Q was less than that of group T, and the difference was statistically significant (P＜0.05). The levels of cortisol, C-reactive protein, interleukin-6, and tumor necrosis factor-α at 48 h after surgery in two groups were higher than those before anesthesia, and those of group Q were lower than those of group T, and the differences were statistically significant (P＜0.05). Conclusion Ultrasound-guided quadratus lumbois block can accelerate the early recovery after kidney transplantation, the postoperative analgesia is significant, and the effect of stress and inflammatory response is small.

Key words： Ultrasound guidance Quadratus lumbois block Renal transplantation Early outcome

基金资助:广西壮族自治区卫生健康委员会自筹经费科研课题（Z20210118）。

通讯作者: 李洪（1974.12-），男，硕士，主任医师；研究方向：移植麻醉与疼痛诊疗。

作者简介: 周汝虹（1982.6-），女，硕士，副主任医师；研究方向：心胸麻醉与移植麻醉。

引用本文:

周汝虹　　杨旭亮　　何爱梅　　李洪. 超声引导下腰方肌阻滞对肾移植受体术后早期转归的影响[J]. 中国医药导报, 2023, 20(31): 114-118,128.
ZHOU Ruhong YANG Xuliang HE Aimei LI Hong. Effect of ultrasound-guided quadratus lumbois block on early outcome after renal transplantation. 中国医药导报, 2023, 20(31): 114-118,128.

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https://www.yiyaodaobao.com.cn/CN/10.20047/j.issn1673-7210.2023.31.24 或 https://www.yiyaodaobao.com.cn/CN/Y2023/V20/I31/114

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