【摘要】 目的 探讨后入路腰方肌阻滞（posterior quadratus lumborum block, PQLB）在腹腔镜子宫肌瘤剔除术中应用的安全性。方法 回顾性分析我院妇科2021年7月～2024年7月62例腹腔镜子宫肌瘤剔除术的临床资料，根据术前阻滞方式分为2组：PQLB组和腹横肌平面（transversus abdominis plane, TAP）阻滞组（TAP组）,每组31例。PQLB组在超声引导下行双侧PQLB,每侧给予0.35%罗哌卡因20 ml。TAP组在超声引导下行双侧TAP阻滞，每侧给予0.4%或0.5%罗哌卡因20 ml。记录患者麻醉前（T₀）、阻滞时（T₁）、手术切皮时（T₂）和苏醒期（T₃）平均动脉压和心率，局麻药毒性反应，神经损伤，术中麻醉性镇痛药物用量，术后补救性镇痛药物的种类与用量，术后恶心呕吐（postoperative nausea and vomiting, PONV）等并发症的发生情况等。结果 62例均顺利完成手术。PQLB组与TAP组4个时间点平均动脉压（F=0.323,P=0.572）、心率（F=0.195,P=0.660）差异均无显著性。2组术中阿片类镇痛药物用量（Z=-0.458,P=0.647）和住院时间（Z=-1.652,P=0.099）差异均无显著性。PQLB组术后补救性镇痛药物使用率显著低于TAP组（32.3%vs.74.2%,χ²=10.949,P=0.000）。PQLB组术后48 h内非甾体类抗炎药用量显著低于TAP组[0（0,0） mg vs.400（0,1600） mg,Z=-4.849,P=0.000],阿片类（曲马多）用量无显著差异（Z=-0.045,P=0.964）。2组PONV发生率差异无显著性（P>0.05）。PQLB组患者术后12、24 h腹壁痛和内脏痛数字疼痛评定量表评分均未超过3分。所有患者均未发生局麻药毒性反应和神经损伤。结论 PQLB可以为腹腔镜子宫肌瘤剔除术患者提供完善的镇痛，对于内脏痛有更好的抑制作用，有助于减少术后麻醉性镇痛药用量。更多还原

【Abstract】 Objective To explore the safety and feasibility of posterior quadratus lumborum block（PQLB） in patients undergoing laparoscopic myomectomy. Methods A retrospective analysis was conducted on clinical data of 62 gynecological patients who underwent laparoscopic myomectomy from July 2021 to July 2024. The patients were divided into two groups based on the preoperative blocking method: the PQLB group and the transversus abdominis plane block（TAP） group, with 31 patients in each group. In the PQLB group, bilateral PQLB was performed under ultrasound guidance with 20 ml of 0.35% ropivacaine on each side. In the TAP group, bilateral transversus abdominis plane blocks were performed under ultrasound guidance with 20 ml of 0.4% or 0.5% ropivacaine on each side. The mean arterial pressure and heart rate were recorded before anesthesia（T₀）, at the time of the block（T₁）, at skin incision（T₂）, and during the recovery period（T₃）. The local anesthetic toxicity, nerve injury, intraoperative opioid consumption, postoperative remedial analgesic usage and dosage, as well as the incidence of nausea and vomiting, were monitored. Results The operations were successfully completed in all the 62 patients. No significant differences were observed between the two groups in mean arterial pressure（F=0.323, P=0.572） and heart rate（F=0.195, P=0.660） at 4 different time points. There were no significant differences in the dosage of anesthetic analgesics during surgery（Z=-0.458, P=0.647） and length of hospital stay（Z=-1.652, P=0.099） between the two groups. The postoperative remedial analgesic usage rate in the PQLB group was significantly lower than that in the TAP group（32.3% vs. 74.2%, χ²=10.949, P=0.000）. Within 48 h after operation, the use of non-steroidal anti-inflammatory drugs（NSAIDs） dosage in the PQLB group was significantly lower than that in the TAP group [0（0,0）mg vs.400（0,1600）mg, Z=-4.849, P=0.000], and no significant difference was observed between the two groups in the use of opioid（tramadol） dosage（Z=-0.045, P=0.964）. There was no significant difference in the incidence of postoperative nausea and vomiting（P>0.05）. The scores of numeric rating scale for abdomial wall pain and visceral pain in the PQLB group at 12 and 24 h after surgery did not exceed 3 points.No local anesthetic toxicity or nerve injury was observed. ConclusionPQLB provides effective analgesia for patients undergoing laparoscopic myomectomy, offering better control of visceral pain, helping reduce intraoperative opioid consumption, and lowering the risk of postoperative adverse reactions.更多还原