摘要目的 评价超声引导连续前路腰方肌阻滞用于全髋关节置换术后镇痛的效果.方法 择期蛛网膜下腔阻滞下行全髋关节置换术患者50例,年龄65 ～ 80岁,体重45 ～ 80 kg,性别不限,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组(n=25):超声引导连续前路腰方肌阻滞组(Q组)和常规镇痛组(R组).Q组于术毕行超声引导连续前路腰方肌阻滞.2组术后行舒芬太尼PCIA.采用地佐辛进行补救镇痛.记录术后Ramsay镇静评分、髋关节最大曲屈和外展活动度;记录术后舒芬太尼总用量、地佐辛使用情况及不良反应发生情况、腰方肌阻滞相关并发症发生情况.结果 与R组比较,Q组术后Ramsay评分降低,髋关节最大曲屈和外展活动度增加,舒芬太尼总用量、地佐辛使用率及恶心、呕吐发生率降低(P＜0.05).Q组未见腰方肌阻滞相关并发症发生.结论 超声引导连续前路腰方肌阻滞可为全髋关节置换术患者提供较完善的术后镇痛,减少术后阿片类药物用量,且不良反应少.

abstractsObjective To evaluate the effect of ultrasound-guided continuous anterior quadratus lumborum block (QLB) on postoperative analgesia in total hip arthroplasty.Methods Fifty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes,aged 65-80 yr,weighing 45-80 kg,scheduled for elective total hip arthroplasty under subarachnoid block,were divided into 2 groups (n =25 each) using a random number table method:ultrasound-guided continuous anterior quadratus lumborum block group (group Q) and routine analgesia group (group R).Anterior QLB was performed at the end of operation in group Q.Patient-controlled intravenous analgesia was performed with sufentanil after operation in two groups.Dezocine was given as rescue analgesic.Ramsay sedation score and the maximum angle for hip flexion and abduction of hip joint were recorded after operation,and the total consumption of sufentanil,requirement for dezocine and occurrence of adverse reactions were recorded within 72 h after operation.The occurrence of QLB-related complications was also recorded.Results Compared with group R,Ramsay sedation score was significantly decreased and the maximum angle for hip flexion and abduction of hip joint were increased at each time point after operation,and the total consumption of sufentanil,requirement for dezocine and incidence of nausea and vomiting were decreased in group Q (P ＜ 0.05).No QLB-related complications were found in group Q.Conclusion Ultrasound-guided continuous anterior QLB can produce better postoperative analgesia and reduce postoperative consumption of opioids with fewer adverse reactions in the patients undergoing total hip arthroplasty.