超声引导下腰方肌阻滞对全髋关节置换患者术后疼痛和恢复质量的影响

Effects of ultrasound-guided quadratus lumborum block on postoperative pain and quality of recovery in patients undergoing total hip arthroplasty

摘要:

目的 探讨超声引导下腰方肌阻滞(QLB)对行全髋关节置换术(THA)患者术后疼痛和恢复质量的影响。方法 选择2018年12月至2019年9月徐州医科大学附属医院择期全身麻醉下行THA患者60例,采用随机数表法随机将患者分为对照组(C组)和阻滞组(Q组),每组30例。Q组患者在全身麻醉诱导前行腰方肌阻滞,C组不进行阻滞。患者术后均使用自控静脉镇痛泵。评估患者术后4、8、24、48h静息时和运动时视觉模拟疼痛评分(VAS)。采用15项恢复质量评分量表(QoR-15)评估患者术后24h恢复质量；采用阿森斯失眠量表(AIS)评估患者术后第1晚睡眠质量；采用躁动评分评估患者苏醒期躁动状态；采用Ramsay镇静评分评估患者拔管后10min镇静状态。记录患者术中全麻药的用量、术后补救镇痛例数、不良反应和住院时间。采用SPSS19.0 统计软件进行数据分析。结果 Q组患者术后4、8、24h静息时VAS评分分别为1(1,2)、2(1,2)、2(1,3)；C组患者分别为3(2,3)、3(2,4)、3(2,5),差异均有统计学意义(均P＜0.05)。Q组患者术后4、8、24h运动时VAS评分分别为3(2,4)、3(2,4)、5(4,6)；C组患者分别为6(5,7)、6(5,8)、7(6,8),差异有统计学意义(均P＜0.05)。2组患者术后48h VAS评分比较,差异无统计学意义(P＞0.05)。Q组患者术后24h QoR-15评分显著高于C组[(99.2±9.7)和(74.4±9.1);P＜0.05],术后第1晚阿森斯失眠量表评分显著低于C组[(9.8±2.4)和(16.0±3.6);P＜0.05]。Q组患者苏醒期躁动评分显著低于C组[0(0,1)和2(1,2);P＜0.05],拔管后10min Ramsay镇静评分显著高于C组[3(2,3)和1(1,1);P＜0.05]。Q组患者术中瑞芬太尼用量和术后补救镇痛率显著低于C组[(1.15±0.23)和(1.73±0.26)mg, 23.3%和53.3%；均P＜0.05]。2组患者住院时间和恶心呕吐发生率比较,差异无统计学意义(P＞0.05)。结论 QLB为THA患者提供良好的术后镇痛,并提高术后早期恢复质量。

Abstract:

Objective To investigate the effects of ultrasound-guided quadratus lumborum block (QLB) on postoperative pain and quality of recovery (QoR) in patients after total hip arthroplasty (THA). Methods A total of 60 patients were enrolled for analysis, who underwent elective THA under general anesthesia in the Affiliated Hospital of Xuzhou Medical University from December 2018 to September 2019. They were randomized into control group (group C) and block group (group Q), with 30 in each group. Patients in group Q received QLB before general anesthesia, and those in group C did not. Both groups used patient-controlled intravenous analgesia pump after the operation. The visual analogue score (VAS) at rest and in movement were assessed postoperatively at 4,8, 24, and 48 h. The quality of recovery at postoperative 24 h was assessed using the quality of recovery questionnaire 15(QoR-15), and sleep quality on the first postoperative night was assessed using the Athens insomnia scale (AIS). The agition during awakening was assessed using the agition scores,the sedation at 10 min after extubation was assessed using the Ramsay sedation scale. The amount of general anesthetics, the number of postoperative salvage analgesia, adverse reactions and duration of hospital stay were documented. SPSS statistics 19.0 was used for data analysis. Results The VAS at rest at 4,8, and 24h were 1 (1,2), 2 (1,2) and 2 (1,3) for group Q and 3 (2,3),3 (2,4) and 3 (2,5) for group C, the difference being statistically significant (P＜0.05). The VAS in movement at 4,8, and 24h were 3 (2,4),3 (2,4) and 5 (4,6) for group Q and 6 (5,7),6 (5,8) and 7 (6,8) for group C, the difference being statistically significant (all P＜0.05). There was no significant difference in the VAS between the two groups at postoperative 48h (P＞0.05). The QoR-15 score at postoperative 24h in group Q was significantly higher than that in group C [(99.2±9.7) vs (74.4±9.1);P＜0.05], and the AIS on the first night after surgery in group Q was significantly lower than that in group C [(9.8±2.4) vs (16.0±3.6);P＜0.05]. The agitation score in group Q was significantly lower than that in group C [0(0,1) vs 2(1,2);P＜0.05]and the Ramsay sedation score at 10 minutes after extubation in group Q was significantly higher than that in group C [3(2,3)vs 1(1,1); P＜0.05]. The amount of remifentanil [(1.15±0.23) vs (1.73±0.26) mg] during surgery and the rate of salvage analgesia (23.3% vs 53.3%) in group Q were significantly lower than those in group C(all P＜0.05). There was no significant difference in the duration of hospital stay and the incidence of nausea and vomiting between the two groups (P＞0.05). Conclusion Ultrasound-guided QLB provides good postoperative analgesia for THA patients and improves early recovery.