2025 年第 10 期 第 20 卷

超声引导下腰方肌阻滞联合全身麻醉在老年腹腔镜肾癌根治术中的应用研究

Study on the application of ultrasound-guided quadratus lumborum block combined with general anesthesia in elderly patients undergoing laparoscopic radical nephrectomy

作者：孙晓佳1汪业铭1孟晨雪1刘禹濛2赵立春3赵继波1

英文作者：Sun Xiaojia1 Wang Yeming1 Meng Chenxue1 Liu Yumeng2 Zhao Lichun3 Zhao Jibo1

单位：1河北北方学院附属第一医院麻醉科，张家口075000；2河北北方学院研究生院，张家口075000；3河北北方学院附属第一医院手术室，张家口075000

英文单位：1Department of Anesthesiology the First Affiliated Hospital of Hebei North University Zhangjiakou 075000 China; 2Graduate School of Hebei North University Zhangjiakou 075000 China; 3Operating Room the First Affiliated Hospital of Hebei North University Zhangjiakou 075000 China

关键词：腹腔镜肾癌根治术；超声引导下腰方肌阻滞；全身麻醉

英文关键词：Laparoscopicradicalnephrectomy;Ultrasound-guidedquadratuslumborumblock;Generalanesthesia

• 摘要：

• 目的 分析超声引导下腰方肌阻滞联合全身麻醉在老年腹腔镜肾癌根治术中的应用效果。方法 选择2021年8月至2022年8月于河北北方学院附属第一医院入院治疗的60例老年肾癌患者，均接受腹腔镜肾癌根治术，按随机数字表法分为G组和OSA组。G组采取传统阿片类药物全身麻醉，OSA组采用超声引导下腰方肌阻滞联合阿片类药物全身麻醉。比较2组麻醉药物用量、镇静与镇痛效果、血清疼痛因子水平、睡眠质量及认知功能。结果 OSA组术中瑞芬太尼、丙泊酚用量均显著低于G组［（1.12±0.22）mg比（1.36±0.31）mg、（513±9）mg比（533±9）mg］，术后24 h内镇痛泵按压次数、补救镇痛率显著少于/低于G组［（3.3±0.8）次比（7.6±1.0）次、13.3%（4/30）比36.7%（11/30）］（均P＜0.05）。OSA组术后12、24、48 h时的静息视觉模拟量表（VAS）评分、活动VAS评分均低于G组，Ramsay镇静评分均高于G组（均P＜0.05）。OSA组术后12、24、48 h时的血清P物质、β-内啡肽、一氧化氮水平均低于G组（均P＜0.05）。OSA组术后12、24、48 h时的简易精神状态量表评分均高于G组，匹兹堡睡眠质量指数评分均低于G组（均P＜0.05）。结论 老年腹腔镜肾癌根治术采用超声引导下腰方肌阻滞联合全身麻醉能减少麻醉药物使用，有效调节血清疼痛因子表达，镇静、镇痛效果更好，能减轻手术对睡眠质量和认知功能的影响。

• Objective To analyze the application effect of ultrasound-guided quadratus lumborum block combined with general anesthesia in elderly patients undergoing laparoscopic radical nephrectomy. Methods Sixty elderly patients with renal cell carcinoma admitted to the First Affiliated Hospital of Hebei North University from August 2021 to August 2022 were selected. All patients underwent laparoscopic radical nephrectomy and were divided into G group and OSA group by random number table method.Patients in G group received conventional opioid general anesthesia, and patients in OSA group received ultrasound-guided quadratus lumborum block combined with opioid general anesthesia. The dosage of anesthetic drugs, sedative and analgesic effects, serum pain factor levels, sleep quality and cognitive function were compared between the two groups. Results The intraoperative consumptions of remifentanil and propofol in OSA group were significantly lower than that in G group［（1.12±0.22）mg vs （1.36±0.31）mg, （513±9）mg vs （533±9）mg］, and the pressing times of analgesic pump and the requirement for rescue analgesia within 24 h after operation were significantly less/lower than those in G group ［(3.3±0.8)times vs (7.6±1.0)times, 13.3%(4/30) vs 36.7%(11/30)］(all P＜0.05). The resting visual analogue scale (VAS) score and active VAS score in OSA group were lower than those in G group at 12, 24 and 48 h after surgery, and the Ramsay sedation score was higher than that in G group (all P＜0.05). The serum levels of substance P, β-endorphin and nitric oxide in OSA group were lower than those in G group at 12, 24 and 48 h after operation (all P＜0.05). The Mini-Mental State examination scores of OSA group were higher than those of G group at 12, 24 and 48 h after operation, and the Pittsburgh sleep quality index scores were lower than those of G group (all P＜0.05). Conclusion Ultrasound-guided quadratus lumborum block combined with general anesthesia can reduce the use of anesthetic drugs, effectively regulate the expression of serum pain factors, have better sedative and analgesic effects, and reduce the impact of surgery on sleep quality and cognitive function in elderly patients undergoing laparoscopic radical nephrectomy.