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右美托咪定复合罗哌卡因弓状韧带上腰方肌阻滞在开腹肝癌切除术中的应用
Application of dexmedetomidine combined with ropivacaine for quadratus lumborum block at the lateral supra-arcuate ligament in open hepatocellular carcinoma resection
- 局解手术学杂志 2025年34卷第1期 页码：62-66
- 作者机构：
1.青岛大学附属医院麻醉科，山东 青岛 266555
2.济宁市第一人民医院麻醉科，山东 济宁272011
3.济宁市第一人民医院肝胆外科，山东 济宁 272011
- 作者简介：
李瑜，E-mail：qyfyly@163.com
- 基金信息：济宁市重点研发计划(2021YXNS023)
DOI：10.11659/jjssx.03E024008
中图分类号： R614纸质出版日期：2025-01-25，
收稿日期：2024-03-03，
- 稿件说明：
移动端阅览
宁双涛, 孔宪刚, 吕坤, 等. 右美托咪定复合罗哌卡因弓状韧带上腰方肌阻滞在开腹肝癌切除术中的应用[J]. 局解手术学杂志, 2025,34(1):62-66.
NING SHUANG-TAO, KONG XIAN-GANG, LYU KUN, et al. Application of dexmedetomidine combined with ropivacaine for quadratus lumborum block at the lateral supra-arcuate ligament in open hepatocellular carcinoma resection. [J]. Journal of regional anatomy and operative surgery, 2025, 34(1): 62-66.
宁双涛, 孔宪刚, 吕坤, 等. 右美托咪定复合罗哌卡因弓状韧带上腰方肌阻滞在开腹肝癌切除术中的应用[J]. 局解手术学杂志, 2025,34(1):62-66. DOI： 10.11659/jjssx.03E024008.
NING SHUANG-TAO, KONG XIAN-GANG, LYU KUN, et al. Application of dexmedetomidine combined with ropivacaine for quadratus lumborum block at the lateral supra-arcuate ligament in open hepatocellular carcinoma resection. [J]. Journal of regional anatomy and operative surgery, 2025, 34(1): 62-66. DOI： 10.11659/jjssx.03E024008.
摘要
目的
2
探讨右美托咪定复合罗哌卡因弓状韧带上腰方肌阻滞（QLB-LSAL）在开腹肝癌切除术中的应用效果。
方法
2
选取60例在济宁市第一人民医院择期行开腹肝癌切除术的患者进行前瞻性研究，随机将其分为复合组和对照组，每组30例。复合组患者给予QLB-LSAL复合全身麻醉，对照组患者给予单纯全身麻醉，所有患者术后均行静脉自控镇痛（PCIA）。观察并比较2组患者不同时点的平均动脉压（MAP）、心率（HR）、静息和咳嗽时疼痛视觉模拟量表（VAS）评分；记录患者术后PCIA按压次数、舒芬太尼用量、术后首次排气时间、术后首次下床活动时间、住院时间及不良反应发生情况。
结果
2
复合组患者切皮时（T2）、手术结束时（T3）时HR和MAP显著低于对照组，出麻醉恢复室时及术后6 h、12 h静息和咳嗽时VAS评分显著低于对照组，PCIA按压次数显著少于对照组，术后0~24 h舒芬太尼用量显著少于对照组，术后25~48 h舒芬太尼用量多于对照组，术后首次下床活动时间及术后首次排气时间显著早于对照组，差异均有统计学意义（
P
<
0.05）。2组患者入室5 min（T0）、切皮前5 min（T1）时HR、MAP，术后24 h、48 h静息和咳嗽时VAS评分，住院时间及不良反应发生率比较，差异均无统计学意义（
P
>
0.05）。
结论
2
右美托咪定复合罗哌卡因QLB-LSAL可为开腹肝癌切除术患者提供更理想的术后镇痛，降低围术期阿片类药物用量，且对循环的影响较小，有利于术后快速康复。
Abstract
Objective
2
To explore the application effect of dexmedetomidine combined with ropivacaine for quadratus lumborum block at the lateral supra-arcuate ligament（QLB-LSAL） in open hepatocellular carcinoma resection.
Methods
2
A prospective study was conducted in 60 patients who underwent elective open hepatocellular carcinoma resection at Jining First People's Hospital.The patients were randomly divided into the compound group and the control group， with 30 cases in each group.Patients in the compound group received QLB-LSAL combined general anesthesia， and patients in the control group received simple general anesthesia. All patients underwent patient controlled intravenous analgesia （PCIA）postoperatively.The mean arterial pressure （MAP），heart rate （HR） and visual analogue scale （VAS） scores during rest and coughing at different time points were observed and compared between the two groups.The number of postoperative PCIA compressions， the dosage of sufentanil， the first postoperative exhaust time， the first postoperative ambulation time， the hospital stay and the occurrence of adverse reactions of the two groups were recorded.
Results
2
In the compound group，the HR and MAP were significantly lower than those o
f the control group at the time of skin incision （T2） and at the end of surgery （T3）；the VAS scores during rest and coughing were significantly lower than those of the control group at the time of exiting the anesthesia recovery room and 6 hours and 12 hours after surgery； and the PCIA compression times were significantly less than those of the control group； the dosage of sufentanil was significantly lower than that in the control group 0 to 24 hours after surgery， and the dosage of sufentanil was higher than that in the control group 25 to 48 hours after surgery； the first postoperative ambulation time and the first postoperative exhaust time were significantly earlier than those in the control group； and the above differences were statistically significant（
P
<
0.05）.There was no significant difference in the HR or MAP at 5 minutes into the operating room （T0） and 5 minutes before skin incision （T1）， VAS scores during rest and coughing 24 hours and 48 hours after surgery， hospital stay and incidence of adverse reactions between the two groups （
P
>
0.05）.
Conclusion
2
For patients with open hepatocellular carcinoma resection， dexmedetomidine combined with ropivazine for QLB-LSAL can provide more ideal postoperative analgesia， reduce perioperative opioid consumption， and have less impact on circulatory system， which is conducive to rapid postoperative recovery.
关键词
弓状韧带上腰方肌阻滞右美托咪定肝癌切除术术后早期恢复术后镇痛
Keywords
quadratus lumborum block at the lateral supra-arcuate ligamentdexmedetomidinehepatocellular carcinoma resectionearly postoperative recoverypostoperative analgesia
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