超声引导下2种神经阻滞方法在腹腔镜全子宫切除术中麻醉效果与安全性比较

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中图分类号：R614.4文献标志码：A DOI：10.11958/20253133

Abstract： ObjectiveTo compare the efficacy safety ultrasound-guided anterolateral lumbar flexus block over thearcuate ligament with transversus abdominis plane block （TAPB）for anesthesia in laparoscopic total hysterectomy. MethodsA total 2O patients who underwent laparoscopic total hysterectomyat our hospital between October 2020 October 2023 were selected romly assigned to two groupsusing arom numbertable.The control groupunderwent TAPB under ultrasound guidance preoperatively，while theobservation groupreceivedbilateral pre-quadratus lumborum block overthe arcuate ligament under ultrasound guidance.Both groups received patient-controlled intravenous analgesia （PCIA）postoperatively.The following parameters were compared between thetwo groups，including hemodynamic status， intraoperativeremifentanilconsumption，intraoperativepropolconsumption，stress response，visualanalog scale （VAS） scores，analgesic eficacy postoperative recovery indicators.ResultsThe heartrate mean arterial pressure at intubation（T） extubation（T2）were higherinboth groups thanthoseatadmision（TO），thosewerelowerinthe observation group than the control group （ P<0.05 ）.The dosage remifentanil was less during surgery in the observation groupthan thosethecontrol group，whilethere was no significant diffrenceinpropolusage betweenthetwo groups（ P> 0.05）.Attheend surgery24hours postoperatively，levels epinephrine （AE），dopamine（DA） norepinephrine （NE）were elevated inboth groups compared to preoperativelevels.However，theselevels werelowerintheobservation group than those in the control group at both time points （ P<0.05 ）. The VAS scores pain at rest during exercise at 6，2，24 48 hours aftersurgerywerelowerintheobservation group thanthose inthecontrol group.The numbercompressions theanalgesicpump，therateremedialanalgesia，thetimetogetoutbedmovearound，thetimetistehaust were less in the observation group than those in the control group （ P<0.05 ）.ConclusionUltrasound-guided anterolateral block the superior lumbar quadratus muscle over the arcuate ligament foruse in laparoscopic total hysterectomy can stabilize haemodynamics，reduce body stress response provide good analgesia.

Keywords：hysterectomy；laparoscopy；nerveblock；ultrasound-guided anterolateral lumbar flexusblock on the arcuate ligament; transversus abdominis plane block

腹腔镜全子宫切除术是治疗子宫内膜癌、子宫颈癌及部分子宫良性疾病的常用手术方式[-2]，其具有微创、住院时间短等优点，在临床中应用广泛[3]。（剩余10423字）