术前超声引导下腰方肌阻滞联合全身麻醉对肾移植患者术后血清应激反应和疼痛相关指标的影响

摘要 目的：探讨术前超声引导下腰方肌阻滞（QLB）联合全身麻醉对肾移植患者术后血清应激反应和疼痛相关指标的影响。方法：选择我院2019年9月~2021年8月期间收治的行肾移植手术的患者82例作为观察对象。根据随机数字表法分为A组和B组，分别为41例。A组给予全身麻醉，B组给予术前超声引导下QLB联合全身麻醉，对比两组静息视觉疼痛模拟（VAS）评分、自控静脉镇痛中的舒芬太尼使用量、有效按压次数，对比两组术后血清应激反应和疼痛相关指标变化，对比两组不良反应发生情况。结果：B组术后6 h、12 h、24 h、48 h静息VAS评分低于A组（P<0.05）。B组自控静脉镇痛中的舒芬太尼使用量少于A组，有效按压次数少于A组（P<0.05）。B组拔管后、术后24 h血糖（Glu）、皮质醇（Cor）低于A组（P<0.05）。两组术后24 h P物质（SP）、前列腺素E₂（PGE₂）及5-羟色胺（5-HT）均升高，但B组低于A组（P<0.05）。两组的不良反应发生率对比无差异（P<0.05）。结论：术前超声引导下QLB联合全身麻醉用于肾移植手术患者，可有效减轻疼痛和应激反应，减少自控静脉镇痛中的舒芬太尼使用量、有效按压次数，且不增加不良反应发生率。

Effect of Preoperative Ultrasound-Guided Quadratus Lumborum Block Combined with General Anesthesia on Serum Stress Response and Pain Related Indexes in Patients with Renal Transplantation

ABSTRACT Objective: To investigate the effect of preoperative ultrasound-guided quadratus lumborum block (QLB) combined with general anesthesia on serum stress response and pain related indexes in patients with renal transplantation. Methods: 82 patients undergoing renal transplantation in our hospital from September 2019 to August 2021 were selected as the observation objects. According to the random number table method, they were divided into group A and group B, 41 cases respectively. Group A was given general anesthesia, and group B was given preoperative ultrasound-guided QLB combined general anesthesia. The resting visual pain simulation (VAS) score, the dosage of sufentanil in patient-controlled intravenous analgesia, the number of effective compressions were compared between the two groups, the changes of serum stress response and pain related indexes were compared between the two groups, and the incidence of adverse reactions were compared between the two groups. Results: The resting VAS scores at 6 h, 12 h, 24 h and 48 h after operation in group B were lower than those in group A(P<0.05). The dosage of sufentanil in patient-controlled intravenous analgesia in group B was less than that in group A, and the number of effective compressions was less than that in group A (P<0.05). Blood glucose (Glu) and cortisol (Cor) in group B after extubation and 24 h after operation were lower than those in group A (P<0.05). Substance P (SP), prostaglandin E₂ (PGE₂) and serotonin (5-HT) increased 24 h after operation in the two groups, but group B was lower than group A(P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P<0.05). Conclusion: Preoperative ultrasound-guided QLB combined with general anesthesia for patients with renal transplantation can effectively reduce pain and stress response, reduce the dosage of sufentanil in patient-controlled intravenous analgesia and the number of effective compressions, and do not increase the incidence of adverse reactions.