超聲引導下不同入路腰方肌阻滯在老年腹腔鏡膽囊切除術中的應用效果比較

Comparison of the Application Efect of Different Approaches of Quadratus Lumborum Block under Ultrasound Guidance in ElderlyLaparoscopic Cholecystectomy/LU Yang， ZHAO Shuang'ou.//Medical Innovation ofChina，2025，22（20）：010-015

[Abstract]Objective： To compare the application effects of different approaches of quadratus lumborum blockunder ultrasound guidance in elderlylaparoscopic cholecystectomy.Method： A total of 12Oelderly patients withbenign gallbladder diseases scheduled forlaparoscopic cholecystectomy at Yueqing People's Hospital from December 2O22 to December 2O23 were selected，they were randomly divided into group A and group B，with 60 cases in each group. Before anesthesia induction，under ultrasound guidance， group A received a transarcuate ligament quadratus lumborum block，while group B underwent an anterior quadratus lumborum block，both with （204 20mL of 0.25% Ropivacaine. During the operation， both groups were induced with Sufentanil， Propofol，and Rocuronium，maintainedwith Remifentanil，Propofol，andocuronium，andreceived patient-controlledintraveous analgesia with Sufentanil after surgery. The operation time， postoperative anal exhaust time，ambulation time， number of rescue analgesia，hospital stay，block operation time，block onset time，numberof block plane segments at different time points after block，heart rate and mean arterial pressure monitored atadmission，before skin incision，and 3 minutes after pneumoperitoneum，cumulative consumptionof Sufentanilatdiferenttimepoints after surgery，VAS scoreatrest，and incidenceof postoperativeanesthesia-relatedadversereactions wererecorded and compared between the two groups.Result： There were no statisticallysignificant differences inoperation time， time to first flatus，and hospital stay between group A and group B （ P gt;0.05）. Group A exhibited earlier postoperative ambulation time and fewer rescue analgesia episodes than group B （ P lt;0.05）.The onset time of block was shorter in groupA，andthe number of blocked dermatomal segments at5and10 min post-block weresignificantly greater than those in group B （ P lt;0.05）.At 3 minutes after pneumoperitoneum， the heart rate in group A was slower and the mean arterial pressure was lower than those in group B （ P lt;0.05）. The cumulative consumption of Sufentanil at 24 hours after surgery in group A was less than that in group B （ P lt;0.05）. The VAS scores at rest at 2，6，and12 hours after surgery in group A were lower than those in group B （ P lt;0.05）. The incidence of anesthesia-related adverse reactions in group A was 8.33% ， significantly lower than 21.67%in group B （ P lt;0.05）. Conclusion： Ultrasoundguided transarcuate ligament quadratus lumborum block is more efective than anterior quadratus lumborum block， which can improvethe analgesic efect after laparoscopic cholecystectomy in elderly patients，promote postoperative recovery and reduce the incidence of adverse reactions.

[Keywords] Old age Laparoscopic cholecystectomy Arcuate ligament Quadratus lumborum Analgesia

First-author's address： Anesthesia and Surgery Department， Yueqing People's Hospital， Yueqing 325600， China

doi：10.3969/j.issn.1674-4985.2025.20.003

腹腔鏡膽囊切除術已廣泛用于治療膽囊良性疾病，突顯創傷小、恢復快和切口美觀的優點，然而高達 40% 的患者術后存在中重度疼痛，成為影響術后恢復的重要原因[。由于傳統阿片類藥物在腹腔鏡膽囊切除術后鎮痛，極易引起惡心、嘔吐等并發癥，尤其對于老年患者，麻醉相關不良反應更多。近年來，越來越多的研究表明，腰方肌阻滯這一鎮痛方式在老年患者腹腔鏡膽囊切除術中應用，可增加切實的益處，如經前路腰方肌阻滯可有效阻斷體表軀體和內臟疼痛，明顯減少圍手術期阿片類藥物的使用次數和劑量[2-3]。由于經前路腰方肌阻滯的鎮痛效果難以控制，存在起效緩慢、阻滯效果易受筋膜間隙模糊和注射部位不精準影響的情況。近年來，相關研究提出，超聲引導下經弓狀韌帶上腰方肌阻滯，能夠為老年患者腹腔鏡膽囊切除術提供更有效的鎮痛，初步展現起效迅速、鎮痛效果可靠和持久的優點[4。由此推測，經弓狀韌帶上腰方肌阻滯在老年患者腹腔鏡膽囊切除術圍手術期中具有一定優勢，然而關于該入路腰方肌阻滯對患者術后鎮痛效果的研究尚不十分充分，未形成統一定論。因此，本研究致力于比較超聲引導下經弓狀韌帶上腰方肌阻滯和前路腰方肌阻滯在老年患者腹腔鏡膽囊切除術中的應用效果。

1資料與方法

1.1一般資料

選擇樂清市人民醫院2022年12月—2023年12月收治的120例行腹腔鏡膽囊切除術的老年良性膽囊疾病患者作為研究對象，隨機分為A組和B組，各60例。……