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不同剂量布比卡因脂质体用于后路腰方肌阻滞在剖宫产术后镇痛中的应用效果
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| 篇名： | 不同剂量布比卡因脂质体用于后路腰方肌阻滞在剖宫产术后镇痛中的应用效果 |
| TITLE： | Application effects of different doses of bupivacaine liposome in posterior quadratus lumborum block for post-operative analgesia after cesarean section |
| 摘要： | 目的 探讨不同剂量布比卡因脂质体（简称“LB”）用于后路腰方肌阻滞（QLB）在剖宫产（CS）患者术后镇痛中的有效性及安全性。方法本研究采用前瞻性研究法，将2024年6－12月崇州市妇幼保健院收治的行CS的患者168例按随机数字排序法分为LB1组、LB2组、LB3组（199、133、67mg），每组56例。所有患者均在接受腰硬联合麻醉后行CS，术后行自控静脉镇痛和不同剂量LB的双侧后路QLB。观察3组患者术后6、12、24、48、72h时的视觉模拟法评分、Ramsay镇静评分、术后阻滞平面存在情况和肌力分级情况，比较患者首次按压镇痛泵时间、术后72h内舒芬太尼和布托啡诺使用量、镇痛泵按压次数、镇痛补救率、开始泌乳时间、新生儿行为神经测定（NBNA）评分、术后排气时间、尿管留置时间、住院时间和术后72h时的总满意度，并记录术后72h内的不良反应发生情况。结果LB1组、LB2组患者术后6、12、24、48、72h时的静息性及运动性疼痛评分、术后72h内舒芬太尼和布托啡诺使用量、镇痛泵按压次数、镇痛补救率、开始泌乳时间均显著低于或短于LB3组（P＜0.05），术后24、48、72h时存在阻滞平面患者比例、首次按压镇痛泵时间和总满意度均显著高于或长于LB3组（P＜0.05），LB1组患者术后6h肌力≤3级的患者比例显著高于LB2组、LB3组（P＜0.05）；3组患者术后各时间点的Ramsay镇静评分、NBNA评分、术后排气时间、尿管留置时间、住院时间以及不良反应发生情况比较，差异均无统计学意义（P＞0.05）。结论相较于67mg的LB，199、133mg的LB可提高行后路QLB的CS患者术后镇痛效果和总满意度，减少术后镇痛药物的使用，缩短其开始泌乳时间；相较于199、133mg的LB，67mg的LB对CS患者的运动功能影响更小；3种剂量LB对新生儿神经行为能力均无明显影响，且镇静效果和安全性相当。 |
| ABSTRACT： | OBJECTIVE To explore the efficacy and safety of different doses of bupivacaine liposome （referred to as “LB”） in posterior quadratus lumborum block （QLB） for postoperative analgesia in patients undergoing cesarean section （CS）. METHODS In prospective research method， a total of 168 patients undergoing CS admitted to Chongzhou Maternal and Child Health Hospital from June to December 2024 were randomly divided into LB1 group， LB2 group， and LB3 group （LB of 199， 133 and 67 mg， respectively） according to the random number sorting method， with 56 cases in each group. All patients underwent CS after combined spinal-epidural anesthesia， and received patient-controlled intravenous analgesia and bilateral posterior QLB with different doses of LB after the operation. Visual analogue scale score， Ramsay sedation score， the presence of postoperative block planes and muscle strength classification were observed in the three groups of patients at 6， 12， 24， 48 and 72 hours after the operation. The time of the first compression of the analgesic pump， the dosage of sufentanil and butorphanol within 72 hours after surgery， the number of compressions of the analgesic pump， the analgesic rescue rate， the time of initiating lactation， the score of neonatal behavioral neurological assessment （NBNA）， the time of postoperative exhaust， the indwelling time of urinary catheter， the length of hospital stay， and the total satisfaction at 72 hours after surgery were compared. The occurrence of adverse reactions within 72 hours after the operation was recorded. RESULTS The resting and motor pain scores， the dosage of sufentanil and butorphanol within 72 hours after surgery， the number of compressions of the analgesic pump， the analgesic rescue rate， and the time of initiating lactation at 6， 12， 24， 48 and 72 hours after surgery in the LB1 group and the LB2 group were significantly lower or shorter than those in the LB3 group（P＜0.05）. The proportion of postoperative block planes at 24， 48 and 72 hours after surgery， the time of the first compression of the analgesic pump and the total satisfaction in the LB1 group and the LB2 group were significantly higher or longer than those in the LB3 group（P＜0.05）. The proportion of patients with muscle strength≤grade 3 at 6 hours after surgery in the LB1 group was significantly higher than that in the LB2 and the LB3 groups （P＜0.05）. There were no statistically significant differences in the Ramsay sedation scores at each time point after surgery， NBNA scores， postoperative exhaust time， urinary catheter indwelling time， the length of hospital stay， as well as the occurrence of adverse reactions among the 3 groups （P＞0.05）. CONCLUSIONS Compared with 67 mg of LB， 199 mg and 133 mg of LB can improve the postoperative analgesic effect and total satisfaction of CS patients undergoing posterior QLB， reduce the use of postoperative analgesic drugs， and shorten the time to start lactation. Compared with 199 mg and 133 mg of LB， 67 mg of LB has a smaller impact on the motor function of CS patients. All three doses of LB had no significant effect on the neurobehavioral abilities of newborns, and demonstrated comparable sedative efficacy and safety. |
| 期刊： | 2025年第36卷第18期 |
| 作者： | 陈岚；白毅平；谢延红；陈珺玥；杨静 |
| AUTHORS： | CHEN Lan，BAI Yiping，XIE Yanhong，CHEN Junyue，YANG Jing |
| 关键字： | 布比卡因脂质体；后路腰方肌阻滞；剖宫产；术后镇痛 |
| KEYWORDS： | bupivacaine liposome； posterior quadratus lumborum block； cesarean section； postoperative analgesia |
| 阅读数： | 9 次 |
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