河北医科大学学报 ›› 2023, Vol. 44 ›› Issue (11): 1307-1311.doi: 10.3969/j.issn.1007-3205.2023.11.012

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前路腰方肌-阴部神经阻滞联合全麻在经阴道全子宫切除术中的应用价值

  

  1. 1.河北中石油中心医院妇科，河北 廊坊 065000;2.河北中石油中心医院麻醉科，河北 廊坊 065000

  • 出版日期:2023-11-25 发布日期:2023-12-05
  • 作者简介:王亚娟（1986-），女，河北廊坊人，河北中石油中心医院主治医师，医学硕士，从事妇科肿瘤疾病诊治研究。
  • 基金资助:
    河北省廊坊市科学技术研究与发展计划项目（2021013148）

Application value of anterior quadratus lumborum and pudendal nerve block combined with general anesthesia in transvaginal total hysterectomy

  1. 1.Department of Gynecology, Hebei Petro China Central Hospital, Langfang 065000, China; 
    2.Department of Anesthesia, Hebei Petro China Central Hospital, Langfang 065000, China

  • Online:2023-11-25 Published:2023-12-05

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摘要： 目的 探讨前路腰方肌-阴部神经阻滞联合全麻在经阴道全子宫切除术中的应用价值。
方法 选取在我院行择期经阴道全子宫切除+阴道前后壁修补术患者100例，将患者分为前路腰方肌-阴部神经阻滞联合全麻组(QPG组，50例)和前路腰方肌阻滞联合全麻组(QG组，50例)，观察比较2组麻醉情况、运动及静息下视觉模拟（visual analog scale，VAS）评分。
结果 QPG组阻滞起效时间为(6.40±1.13) min，短于QG组(P＜0.05)；QPG组瑞芬太尼、丙泊酚、顺式阿曲库铵的用量分别为(6.40±1.13) min、(810.12±97.55) mg、(660.74±51.21) mg和(17.80±2.21) mg，少于QG组(P＜0.05)。QPG组术后48 h内静脉自控镇痛(patient controlled intravenous analgesia，PCIA)累计用量、术后48 h内PCIA有效按压次数和补救镇痛发生率分别为(38.87±8.12) mL、(6.80±1.22)次和4.00%，少于QG组(P＜0.05)；QPG组苏醒时间、自主呼气恢复时间和拔除喉罩时间分别为(4.20±0.97) min、(5.33±1.02) min和(5.80±1.21) min，短于QG组(P＜0.05)。QPG组运动及静息下术后2 h、8 h、12 h和24 h时VAS评分低于QG组(P＜0.05),在组间、时点间差异有统计学意义（P＜0.05）。
结论 经阴道全子宫切除前路腰方肌-阴部神经阻滞联合全麻有助于减少麻醉药物用量，改善术后镇痛效果。


关键词: 经阴道全子宫切除术, 前路腰方肌阻滞, 阴部神经阻滞, 全麻

Abstract: Objective To investigate the application value of anterior quadratus lumborum and pudendal nerve block combined with general anesthesia in patients undergoing transvaginal total hysterectomy. 
Methods A total of 100 patients who underwent elective transvaginal total hysterectomy + vaginal anterior and posterior wall repair in our hospital were selected, and divided into the anterior quadratus lumborum and pudendal nerve block combined with general anesthesia group (QPG group, n=50) and the anterior quadratus lumborum block combined with general anesthesia group (QG group, n=50). Anesthesia condition, visual analog scale (VAS) score during exercise and at rest were observed and compared between two groups. 
Results The onset time of block in QPG group was (6.40±1.13) min, which was significantly faster than that in QG group (P＜0.05). The doses of remifentanil, propofol and CIS atracurium in QPG group were (810.12±97.55) mg, (660.74±51.21) mg and (17.80±2.21) mg, respectively, which were significantly fewer than those in QG group (P＜0.05). The cumulative dosage of patient receiving patient controlled intravenous analgesia (PCIA) within 48 h after operation, the number of effective PCIA compressions within 48 h after operation and the incidence of remedial analgesia in QPG group were (38.87±8.12) mL, (6.80±1.22) times and 4.00%, respectively, which were significantly less than those in QG group (P＜0.05). The awakening time, spontaneous expiratory recovery time and laryngeal mask removal time in QPG group were (4.20±0.97) min, (5.33±1.02) min and (5.80±1.21) min, respectively, which were significantly faster than those in QG group (P＜0.05). VAS scores at 2 h, 8 h, 12 h and 24 h after operation during exercise and at rest in QPG group were significantly lower than those in QG group (P＜0.05). 
Conclusion Anterior quadratus lumborum and pudendal nerve block combined with general anesthesia after transvaginal total hysterectomy is helpful to reduce the dosage of anesthetic drugs and improve the postoperative analgesic effect. 

Key words: transvaginal total hysterectomy, anterior quadratus lumborum block, pudendal nerve block, general anesthesia

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