超声引导下经弓状韧带上腰方肌阻滞与经前路腰方肌阻滞对腹腔镜胆囊切除术患者镇痛效果对比研究*

doi:10.3969/j.issn.1672-5069.2026.01.037

摘要/Abstract

摘要： 目的比较经弓状韧带上腰方肌阻滞(QLB)与经前路QLB处理接受腹腔镜胆囊切除术(LC)患者镇痛效果的差异。方法 2023年1月～2024年12月我院诊治的胆囊结石患者109例,均接受LC手术治疗。将患者分为两组,分别采取经弓状韧带上QLB(n=51)或和经前路QLB(n=58)行术后镇痛,即在超声引导下分别经弓状韧带上或经前路在腰方肌内或在腰方肌与腰大肌之间的胸腰筋膜处注射0.25%盐酸罗哌卡因注射液进行神经阻滞,术后自控静脉镇痛。采用针刺法评估阻滞平面节段数,采用疼痛视觉模拟量表(VAS)评估疼痛程度。结果经弓状韧带上QLB组术后下床活动时间、首次按压镇痛泵时间和补救镇痛次数分别为(3.8±0.7)h、(5.4±1.1)h和(0.7±0.4)次,均显著优于经前路QLB组【分别为(4.6±0.9)h、(4.8±0.9)h和(1.2±0.6)次,P＜0.05】;经弓状韧带上QLB组阻滞生效时间为(6.7±1.6)min,显著早于经前路QLB组【(8.9±2.5)min,P＜0.05】,在阻滞后5 min、10 min和20 min,阻滞平面节段数分别为(4.1±0.9)个、(7.5±1.7)个和(8.6±1.8)个,均显著多于经前路QLB组【分别为(2.6±0.5)个、(5.3±1.1)个和(6.8±1.3)个,P＜0.05】;在术后6 h、12 h和24 h,经弓状韧带上QLB组静息时VAS评分分别为(1.2±0.3)分、(1.5±0.4)分和(1.7±0.7)分,均显著低于经前路QLB组【分别为(1.6±0.5)分、(1.9±0.8)分和(2.0±0.6)分,P＜0.05】,咳嗽时VAS评分分别为(1.6±0.6)分、(2.3±0.7)分和(2.1±0.6)分,均显著低于经前路QLB组【分别为(2.2±0.9)分、(2.8±1.3)分和(2.5±1.1)分,P＜0.05】。结论采取在超声引导下经弓状韧带上QLB可显著提高LC患者术后镇痛效果,加快机体恢复和减少不良反应的发生。

关键词: 胆囊结石, 腹腔镜胆囊切除术, 神经阻滞, 弓状韧带, 腰方肌, 镇痛

Abstract: Objective The aim of this study was to compare analgesia by ultrasound-guided superior quadratus lumborum block (QLB) through arcuate ligament or by QLB through anterior approach in patients with gallbladder stones undergoing laparoscopic cholecystectomy (LC). Methods A total of 109 patients with gallbladder stones were encountered in our hospital between January 2023 and December 2024, and all underwent LC. For post-operational analgesia, patients were randomly assigned to receive trans-arcuate ligament superior QLB group (n=51) or trans-anterior approach QLB group (n=58). Analgesia was completed with 0.25% ropivacaine hydrochloride injection for nerve block. The number of block plane segments was evaluated by acupuncture, and pain under rest and when cough was evaluated by visual analogue scale (VAS). Results The postoperative ambulation time in trans-arcuate ligament superior QLB group was (3.8±0.7)h, much earlier than [(4.6±0.9)h, P＜0.05] in trans-anterior approach QLB group, first pressing PCA pump after surgery and remedial analgesia were (5.4±1.1)h and (0.7±0.4)times, much later or less than (4.8±0.9)h and (1.2±0.6)times,P＜0.05] in trans-anterior approach QLB group; onset of analgesia was (6.7±1.6)min, much earlier than [(8.9±2.5)min,P＜0.05] in trans-anterior approach QLB group,and by 5 min, 10 min and 20 min after block, numbers of blocking plane segments were (4.1±0.9), (7.5±1.7) and (8.6±1.8)seg, all much greater than [(2.6±0.5), (5.3±1.1) and (6.8±1.3)seg, respectively, P＜0.05] in trans-anterior approach QLB group;by 6 h, 12 h and 24 h post-operationally, the resting VAS scores were (1.2±0.3), (1.5±0.4) and (1.7±0.7), all much lower than [(1.6±0.5), (1.9±0.8) and (2.0±0.6), P＜0.05], and VAS scores at cough were (1.6±0.6), (2.3±0.7) and (2.1±0.6), all much lower than [(2.2±0.9), (2.8±1.3) and (2.5±1.1),P＜0.05] in trans-anterior approach QLB group. Conclusion Superior QLB through arcuate ligament under ultrasound guidance in patients undergoing LC could effectively improve postoperative analgesic effect, accelerating recovery and reduce the occurrence of adverse reactions.

Key words: Cholelithiasis, Laparoscopic cholecystectomy, Nerve block, Arcuate ligament, Quadratus lumborum, Analgesia

杜波, 赵争光, 孙伟. 超声引导下经弓状韧带上腰方肌阻滞与经前路腰方肌阻滞对腹腔镜胆囊切除术患者镇痛效果对比研究^*[J]. 实用肝脏病杂志, 2026, 29(1): 145-148.

Du Bo, Zhao Zhengguang, Sun Wei. A comparative study on analgesia by ultrasound-guided superior quadratus lumborum block through arcuate ligament or by quadratus lumborum block through anterior approach in patients with gall bladder stones undergoing laparoscopic cholecystectomy[J]. Journal of Practical Hepatology, 2026, 29(1): 145-148.

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超声引导下经弓状韧带上腰方肌阻滞与经前路腰方肌阻滞对腹腔镜胆囊切除术患者镇痛效果对比研究^*

A comparative study on analgesia by ultrasound-guided superior quadratus lumborum block through arcuate ligament or by quadratus lumborum block through anterior approach in patients with gall bladder stones undergoing laparoscopic cholecystectomy

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