超声引导下QLB复合气管插管全麻对于老年患者TEP腹股沟疝无张力修补术影响因素分析

摘要 目的：探讨与分析超声引导下腰方肌阻滞(quadratus lumborum block，QLB)复合气管插管全麻对于老年患者腹腔镜下全腹膜外（totally extraperitoneal prosthetic，TEP）腹股沟疝无张力修补术的影响，以促进该方法的临床使用。方法：2014年9月到2020年6月选择在本院诊治的腹股沟疝老年患者180例，根据随机数字表法分为QLB组与对照组各90例。所有患者都给予腹腔镜下全腹膜外腹股沟疝无张力修补术，对照组给予气管插管全麻，QLB组在对照组麻醉的基础上给予超声引导下QLB，记录两组镇痛与麻醉效果。结果：两组的术中出血量、手术时间等对比差异无统计学意义(P>0.05)，QLB组的术后住院时间、术后胃肠功能恢复时间、术后下床活动时间显著短于对照组(P<0.05)。与术后12 h对比，两组术后24 h与36 h的疼痛VAS评分均降低(P<0.05)，且QLB组术后12 h、24 h与36 h的疼痛VAS评分都显著低于对照组(P<0.05)。QLB组术后7 d的血肿、呼吸抑制、脏器损伤、腹股沟区包块等并发症发生率为8.9 %，显著低于对照组的21.1 %(P<0.05)。QLB组的瑞芬太尼用量、术后48 h内有效按压自控静脉镇痛泵次数、自控静脉镇痛泵累计用量都显著少于对照组(P<0.05)。结论：超声引导下QLB复合气管插管全麻在老年患者腹腔镜下全腹膜外腹股沟疝无张力修补术中的应用能提高镇痛与麻醉效果，减少术后并发症的发生，有利于促进患者康复。

Analysis of Influence Factors of Ultrasonic-guided Quadratus Lumborum Block Combined with Endotracheal Intubation for General Anesthesia for Tension-free Repair of Totally Extraperitoneal Prosthetic Inguinal Hernia in Elderly Patients

ABSTRACT Objective: To explore and analysis the effect of ultrasound-guided continuous quadratus lumborum block (QLB) combined with tracheal intubation for elderly patients with laparoscopic totally extraperitoneal prosthetic tension-free inguinal hernia repair, so as to promote the clinical use of this method. Methods: From September 2014 to June 2020, 180 cases of elderly patients with inguinal hernia were selected for diagnosis and treatment in this hospital were selected and were divided into the QLB group and control group with 90 cases each groups accorded to the random number table method. All patients were given laparoscopic totally extraperitoneal prosthetic tension-free inguinal hernia repair, the control group were given general tracheal intubation anesthesia, and the QLB group were given ultrasound-guided QLB on the basis of anesthesia in the control group. The analgesia and anesthesia effects of the two groups were recorded. Results: There were no statistically significant difference in the amount of intraoperative blood loss and operation time compared between the two groups(P>0.05). The postoperative hospital stay, postoperative gastrointestinal function recovery time and postoperative time to get out of bed in the QLB group were significantly shorter control group(P<0.05). Compared with 12 hours after operation, the pain VAS scores of both groups at 24 hours and 36 hours after operation decreased(P<0.05), the pain VAS scores of the QLB group at 12 h, 24 h and 36 h after operation were significantly lower than those of the control group (P<0.05). The incidence of complications such as hematoma, respiratory depression, organ injury, and groin mass in the QLB group at 7 days after operation were 8.9 %, which were significantly lower than the control group''s 21.1 %(P<0.05). The dosage of remifentanil in the QLB group, the number of times the automatic control intravenous analgesia pump was effectively pressed within 48 hours after the operation, and the cumulative dosage of the automatic control intravenous analgesia pump were significantly less than those in the control group(P<0.05). Conclusion: The application of ultrasound-guided QLB combined endotracheal intubation general anesthesia in laparoscopic totally extraperitoneal prosthetic tension-free inguinal hernia repair in elderly patients can improve the analgesia and anesthesia effects, reduce the occurrence of postoperative complications, and promote the recovery of patients.