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Article(id=1241768177416344155, tenantId=1146029695717560320, journalId=1205117082300743687, issueId=1241768176522957402, articleNumber=null, orderNo=null, doi=10.14109/j.cnki.xyylc.2024.05.10, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1678809600000, receivedDateStr=2023-03-15, revisedDate=null, revisedDateStr=null, acceptedDate=1706544000000, acceptedDateStr=2024-01-30, onlineDate=1773990204433, onlineDateStr=2026-03-20, pubDate=1716566400000, pubDateStr=2024-05-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773990204433, onlineIssueDateStr=2026-03-20, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773990204433, creator=13701087609, updateTime=1773990204433, updator=13701087609, issue=Issue{id=1241768176522957402, tenantId=1146029695717560320, journalId=1205117082300743687, year='2024', volume='43', issue='5', pageStart='321', pageEnd='400', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773990204220, creator=13701087609, updateTime=1773992176593, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241776449330414547, tenantId=1146029695717560320, journalId=1205117082300743687, issueId=1241768176522957402, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241776449330414548, tenantId=1146029695717560320, journalId=1205117082300743687, issueId=1241768176522957402, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=369, endPage=373, ext={EN=ArticleExt(id=1241768177747694173, articleId=1241768177416344155, tenantId=1146029695717560320, journalId=1205117082300743687, language=EN, title=Effects of butorphanol combined with quadratus lumborum block on postoperative analgesia and rehabilitation quality in patients with colorectal cancer, columnId=1207314218647392369, journalTitle=Chinese Journal of New Drugs and Clinical Remedies, columnName=Original Article, runingTitle=null, highlight=null, articleAbstract=
AIM

To evaluate the effects of butorphanol combined with quadratus lumborum block （QLB） on postoperative analgesia and early rehabilitation quality in patients with colorectal cancer.

METHODS

Sixty patients undergoing elective laparoscopic radical resection of colorectal cancer under general anesthesia were randomly divided into two groups, with 30 cases in each group. The induction and maintenance of anesthesia were the same in the two groups.Patients in group B received patient-controlled intravenous analgesia （PCIA） with butorphanol 0.2 mg·kg-1 diluted to 200 mL with sodium chloride injection. Patients in group BQ received ultrasound-guided bilateral anterior QLB and 0.25% ropivacaine 20 mL was injected bilaterally on the basis of that in the group B. Visual analogue scale （VAS） and Bruggrmann comfort scale （BCS） were used to evaluate the analgesic effect of the two groups after operation. The serum levels of interleukin （IL）-6, C-reactive protein （CRP） and tumor necrosis factor （TNF） -α were detected before operation and 24 h after operation. The postoperative recovery and hospitalization satisfaction score of the patients were evaluated,the consumption of butorphanol and the requirement for rescue analgesia within 48 h after operation were recorded, and the occurrence of postoperative nausea and vomiting was observed.

RESULTS

The VAS scores of the group BQ were lower than those of the group B at 2, 6, 12 and 24 h after operation （P<0.05）, and the BCS scores of the group BQ were higher than those of the group B （P<0.05）. The levels of IL-6, TNF-α and CRP at 24 h after operation in both groups were higher than those before operation （P<0.05）, but those in the group BQ were lower than those in the group B （P<0.05）. The postoperative anal exhaust time, liquid food intake time, ambulation time and hospitalization time in the group BQ were shorter than those in the group B （P<0.05）, and the hospitalization satisfaction in the group BQ was higher than that in the group B （P<0.05）. The consumption of butorphanol within 48 h after operation in the group BQ was less than that in the group B （P<0.05）, and the requirement for rescue analgesia in the group BQ was lower than that in the group B （P<0.05）.No serious adverse reactions occurred in the two groups, but the incidence of nausea and vomiting in the group BQ was significantly lower than that in the group B （P<0.05）.

CONCLUSION

Butorphanol combined with QLB for postoperative analgesia in patients undergoing laparoscopic radical resection of colorectal cancer can effectively enhance the postoperative analgesic effect, reduce the inflammatory response of the body, and promote the early recovery of patients.

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目的

评价布托啡诺联合腰方肌阻滞（QLB）对结直肠癌患者术后镇痛及早期康复质量的影响。

方法

选择择期全身麻醉下行腹腔镜结直肠癌根治术患者60例，随机分为2组，每组30例，2组麻醉诱导和维持方案相同。术后B组采用患者自控静脉镇痛（PCIA），镇痛液配方为布托啡诺0.2 mg·kg-1，用氯化钠注射液稀释至200 mL；BQ组在B组基础上，在超声引导下行双侧前路QLB，双侧均注射0.25%罗哌卡因20 mL。采用视觉模拟量表（VAS）与Bruggrmann舒适度量表（BCS）评估术后镇痛效果，检测术前、术后24 h血清白细胞介素（IL）-6，C反应蛋白（CRP）及肿瘤坏死因子（TNF）-α浓度，评估患者术后康复情况及住院满意度评分,记录术后补救镇痛、不良反应发生情况。

结果

术后2、6、12和24 h， BQ组VAS评分均显著低于B组（P<0.05），BCS评分均显著高于B组（P<0.05）。术后24 h，2组的IL-6、TNF-α和CRP水平均显著高于术前（P<0.05），而BQ组显著低于B组（P<0.05）。与B组相比，BQ组术后肛门排气时间、进流质食物时间、下床活动时间和住院时间均显著缩短（P<0.05），住院满意度显著增高（P<0.05）。BQ组术后48 h内布托啡诺消耗量少于B组，补救镇痛率低于B组，均有显著差异（P<0.05）。2组均无严重不良反应发生，但恶心呕吐发生率BQ组显著低于B组 （P<0.05）。

结论

布托啡诺联合QLB用于腹腔镜结直肠癌根治术患者术后镇痛，可以有效增强术后镇痛效果，减轻机体炎症反应，促进患者早期康复。

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王旭璐，E-mail:
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王金忠，男，主任医师，学士，主要从事临床麻醉及围术期镇痛管理的研究，E-mail:

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王金忠，男，主任医师，学士，主要从事临床麻醉及围术期镇痛管理的研究，E-mail:

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王金忠，男，主任医师，学士，主要从事临床麻醉及围术期镇痛管理的研究，E-mail:

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指标B组BQ组
年龄/岁69.7±4.270.1±3.5
体重指数/kg·m-223.1±1.022.3±2.1
手术时间/h2.1±0.42.1±0.3
性别（男/女）/例18/1216/14
TNM分期（Ⅰ/Ⅱ）/例14/1613/17
ASA分级（Ⅰ/Ⅱ/Ⅲ）/例6/14/105/14/11
), ArticleFig(id=1241768185444242242, tenantId=1146029695717560320, journalId=1205117082300743687, articleId=1241768177416344155, language=CN, label=表1, caption=

一般资料组间比较

, figureFileSmall=null, figureFileBig=null, tableContent=
指标B组BQ组
年龄/岁69.7±4.270.1±3.5
体重指数/kg·m-223.1±1.022.3±2.1
手术时间/h2.1±0.42.1±0.3
性别（男/女）/例18/1216/14
TNM分期（Ⅰ/Ⅱ）/例14/1613/17
ASA分级（Ⅰ/Ⅱ/Ⅲ）/例6/14/105/14/11
), ArticleFig(id=1241768185595237193, tenantId=1146029695717560320, journalId=1205117082300743687, articleId=1241768177416344155, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别 时点VAS评分BCS评分1.8±0.1
B术后2 h3.2±1.21.8±0.1
术后6 h3.0±0.81.8±0.3
术后12 h2.8±0.61.9±0.4
术后24 h2.7±0.22.4±0.6
术后48 h1.5±0.13.6±0.2
BQ术后2 h2.1±0.8b3.0±0.1b
术后6 h1.8±0.5b3.0±0.3b
术后12 h1.8±0.3b3.3±0.5b
术后24 h1.7±0.1b3.5±0.2b
术后48 h1.4±0.2a3.6±0.2a
), ArticleFig(id=1241768185746232142, tenantId=1146029695717560320, journalId=1205117082300743687, articleId=1241768177416344155, language=CN, label=表2, caption=

不同时点VAS、BCS评分组间比较

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组别 时点VAS评分BCS评分1.8±0.1
B术后2 h3.2±1.21.8±0.1
术后6 h3.0±0.81.8±0.3
术后12 h2.8±0.61.9±0.4
术后24 h2.7±0.22.4±0.6
术后48 h1.5±0.13.6±0.2
BQ术后2 h2.1±0.8b3.0±0.1b
术后6 h1.8±0.5b3.0±0.3b
术后12 h1.8±0.3b3.3±0.5b
术后24 h1.7±0.1b3.5±0.2b
术后48 h1.4±0.2a3.6±0.2a
), ArticleFig(id=1241768185918198613, tenantId=1146029695717560320, journalId=1205117082300743687, articleId=1241768177416344155, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别 时点IL-6/ng·L-1TNF-α/ng·L-1CRP/mg·L-1
B术前16.8±1.312.1±2.28.0±1.3
术后24 h52.5±2.237.5±4.032.9±1.9
差值35.9±1.7b25.2±2.5b25.1±0.8b
BQ术前16.5±1.1d12.2±2.4d8.2±1.0d
术后24 h44.3±1.929.4±3.624.1±1.8
差值27.6±1.6be17.5±2.0be15.5±0.9be
), ArticleFig(id=1241768186069193564, tenantId=1146029695717560320, journalId=1205117082300743687, articleId=1241768177416344155, language=CN, label=表3, caption=

不同时点IL-6、TNF-α及CRP水平组间比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别 时点IL-6/ng·L-1TNF-α/ng·L-1CRP/mg·L-1
B术前16.8±1.312.1±2.28.0±1.3
术后24 h52.5±2.237.5±4.032.9±1.9
差值35.9±1.7b25.2±2.5b25.1±0.8b
BQ术前16.5±1.1d12.2±2.4d8.2±1.0d
术后24 h44.3±1.929.4±3.624.1±1.8
差值27.6±1.6be17.5±2.0be15.5±0.9be
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布托啡诺联合腰方肌阻滞对结直肠癌患者术后镇痛及康复质量的影响
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王金忠 1 , 韩硕 1 , 沈社良 2 , 许佳 1 , 王旭璐 1
中国新药与临床杂志 | 论著 2024,43(5): 369-373
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中国新药与临床杂志 | 论著 2024, 43(5): 369-373
布托啡诺联合腰方肌阻滞对结直肠癌患者术后镇痛及康复质量的影响
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王金忠1 , 韩硕1, 沈社良2, 许佳1, 王旭璐1
作者信息
  • 1.杭州市第九人民医院　麻醉科，浙江　杭州　311225
  • 2.浙江省人民医院　麻醉科，浙江　杭州310014

    • 王金忠，男，主任医师，学士，主要从事临床麻醉及围术期镇痛管理的研究，E-mail:

通讯作者:

王旭璐，E-mail:
Effects of butorphanol combined with quadratus lumborum block on postoperative analgesia and rehabilitation quality in patients with colorectal cancer
Jin-zhong WANG1 , Shuo HAN1, She-liang SHEN2, Jia XU1, Xu-lu WANG1
Affiliations
  • 1.Department of Anesthesiology, Hangzhou Ninth People’s Hospital, Hangzhou ZHEJIANG 311225, China
  • 2.Department of Anesthesiology, People’s Hospital of Zhejiang Province, Hangzhou ZHEJIANG 310014, China
出版时间: 2024-05-25 doi: 10.14109/j.cnki.xyylc.2024.05.10
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摘要
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目的

评价布托啡诺联合腰方肌阻滞（QLB）对结直肠癌患者术后镇痛及早期康复质量的影响。

方法

选择择期全身麻醉下行腹腔镜结直肠癌根治术患者60例，随机分为2组，每组30例，2组麻醉诱导和维持方案相同。术后B组采用患者自控静脉镇痛（PCIA），镇痛液配方为布托啡诺0.2 mg·kg-1，用氯化钠注射液稀释至200 mL；BQ组在B组基础上，在超声引导下行双侧前路QLB，双侧均注射0.25%罗哌卡因20 mL。采用视觉模拟量表（VAS）与Bruggrmann舒适度量表（BCS）评估术后镇痛效果，检测术前、术后24 h血清白细胞介素（IL）-6，C反应蛋白（CRP）及肿瘤坏死因子（TNF）-α浓度，评估患者术后康复情况及住院满意度评分,记录术后补救镇痛、不良反应发生情况。

结果

术后2、6、12和24 h， BQ组VAS评分均显著低于B组（P<0.05），BCS评分均显著高于B组（P<0.05）。术后24 h，2组的IL-6、TNF-α和CRP水平均显著高于术前（P<0.05），而BQ组显著低于B组（P<0.05）。与B组相比，BQ组术后肛门排气时间、进流质食物时间、下床活动时间和住院时间均显著缩短（P<0.05），住院满意度显著增高（P<0.05）。BQ组术后48 h内布托啡诺消耗量少于B组，补救镇痛率低于B组，均有显著差异（P<0.05）。2组均无严重不良反应发生，但恶心呕吐发生率BQ组显著低于B组 （P<0.05）。

结论

布托啡诺联合QLB用于腹腔镜结直肠癌根治术患者术后镇痛，可以有效增强术后镇痛效果，减轻机体炎症反应，促进患者早期康复。

布托啡诺  /  镇痛  /  结直肠肿瘤  /  结直肠外科手术  /  术后加速康复  /  腰方肌阻滞
AIM

To evaluate the effects of butorphanol combined with quadratus lumborum block （QLB） on postoperative analgesia and early rehabilitation quality in patients with colorectal cancer.

METHODS

Sixty patients undergoing elective laparoscopic radical resection of colorectal cancer under general anesthesia were randomly divided into two groups, with 30 cases in each group. The induction and maintenance of anesthesia were the same in the two groups.Patients in group B received patient-controlled intravenous analgesia （PCIA） with butorphanol 0.2 mg·kg-1 diluted to 200 mL with sodium chloride injection. Patients in group BQ received ultrasound-guided bilateral anterior QLB and 0.25% ropivacaine 20 mL was injected bilaterally on the basis of that in the group B. Visual analogue scale （VAS） and Bruggrmann comfort scale （BCS） were used to evaluate the analgesic effect of the two groups after operation. The serum levels of interleukin （IL）-6, C-reactive protein （CRP） and tumor necrosis factor （TNF） -α were detected before operation and 24 h after operation. The postoperative recovery and hospitalization satisfaction score of the patients were evaluated,the consumption of butorphanol and the requirement for rescue analgesia within 48 h after operation were recorded, and the occurrence of postoperative nausea and vomiting was observed.

RESULTS

The VAS scores of the group BQ were lower than those of the group B at 2, 6, 12 and 24 h after operation （P<0.05）, and the BCS scores of the group BQ were higher than those of the group B （P<0.05）. The levels of IL-6, TNF-α and CRP at 24 h after operation in both groups were higher than those before operation （P<0.05）, but those in the group BQ were lower than those in the group B （P<0.05）. The postoperative anal exhaust time, liquid food intake time, ambulation time and hospitalization time in the group BQ were shorter than those in the group B （P<0.05）, and the hospitalization satisfaction in the group BQ was higher than that in the group B （P<0.05）. The consumption of butorphanol within 48 h after operation in the group BQ was less than that in the group B （P<0.05）, and the requirement for rescue analgesia in the group BQ was lower than that in the group B （P<0.05）.No serious adverse reactions occurred in the two groups, but the incidence of nausea and vomiting in the group BQ was significantly lower than that in the group B （P<0.05）.

CONCLUSION

Butorphanol combined with QLB for postoperative analgesia in patients undergoing laparoscopic radical resection of colorectal cancer can effectively enhance the postoperative analgesic effect, reduce the inflammatory response of the body, and promote the early recovery of patients.

butorphanol  /  analgesia  /  colorectal neoplasms  /  colorectal surgery  /  enhanced recover after surgery  /  quadratus lumborum block
王金忠, 韩硕, 沈社良, 许佳, 王旭璐. 布托啡诺联合腰方肌阻滞对结直肠癌患者术后镇痛及康复质量的影响. 中国新药与临床杂志, 2024 , 43 (5) : 369 -373 . DOI: 10.14109/j.cnki.xyylc.2024.05.10
Jin-zhong WANG, Shuo HAN, She-liang SHEN, Jia XU, Xu-lu WANG. Effects of butorphanol combined with quadratus lumborum block on postoperative analgesia and rehabilitation quality in patients with colorectal cancer[J]. Chinese Journal of New Drugs and Clinical Remedies, 2024 , 43 (5) : 369 -373 . DOI: 10.14109/j.cnki.xyylc.2024.05.10
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结直肠癌是常见的胃肠道恶性肿瘤，腹腔镜结直肠癌根治术在临床已广泛应用［1］，该术式虽属微创，但术后患者仍伴有中重度疼痛，影响患者的快速康复［2］。布托啡诺（butorphanol）为一种较新的阿片受体激动-拮抗剂，被广泛用于围术期镇痛，具有较好的镇痛效果和较少的副作用［3］。腰方肌阻滞（quadratus lumborum block, QLB）是利用超声引导穿刺针将局部麻醉（局麻）药注射至腰方肌周围，药液随胸腰筋膜扩散至胸椎旁间隙，继而发挥镇痛效应［4］。为获得更好的术后镇痛效果，加速康复外科（enhanced recovery after surgery, ERAS）中推荐个体化的围术期多模式镇痛方案［5］。因此，本研究拟评价布托啡诺联合QLB对结直肠癌患者术后镇痛及早期康复质量的影响,以供临床参考。
资料与方法
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病例选择和分组
选择2021年1月至2023年1月在杭州市第九人民医院择期行腹腔镜结直肠癌根治术患者60例。纳入标准：术前经细胞学、肠镜检查已明确诊断，术后病理证实为结直肠癌的患者；ASA分级Ⅰ~Ⅲ级，临床TNM分期Ⅰ~Ⅱ期。排除标准：严重心血管疾病，中重度肝功能损伤（丙氨酸转氨酶或天冬氨酸转氨酶>80 U·L-1）、 严重肾功能损伤（肌酐清除率<10 mL·min-1），术前有局麻药过敏史、阿片类药物过敏或滥用史，腰方肌的阻滞部位感染，凝血功能障碍。本研究通过杭州市第九人民医院伦理委员会审批（编号：研伦第2021-17），患者及家属均签署知情同意书。按入院时间顺序采用随机数字表法将患者均分为B组（布托啡诺组）和BQ组（布托啡诺联合QLB组），每组30例。2组患者一般资料比较，差异无显著意义（P>0.05），见表1。
麻醉与镇痛方法
所有患者入手术室后开放外周静脉，行心电图（ECG）、心率（HR）、脉搏氧饱和度（SpO2）、有创动脉血压（IBP）、呼气末二氧化碳分压（PETCO2）及脑电双频谱指数（BIS）监测。所有患者均采用气管插管全身麻醉，麻醉诱导：依次静脉注射（静注）咪达唑仑0.03 mg·kg-1、依托咪酯0.3 mg·kg-1、舒芬太尼0.5 μg·kg-1、罗库溴胺0.8 mg·kg-1，诱导后使用可视喉镜行气管插管，连接麻醉机行机械通气，调节参数PETCO2维持在35~45 mmHg。麻醉维持：静脉微泵输注丙泊酚4~10 mg·kg-1·h-1、瑞芬太尼0.1~0.3 μg·kg-1·min-1，持续吸入0.8%~1.5%七氟烷，术中BIS值维持在40~60。术后所有患者待麻醉清醒意识恢复，自主呼吸满意，拔除气管导管后送至恢复室。入恢复室即刻启动术后镇痛，B组采用患者自控静脉镇痛（PCIA），布托啡诺（江苏恒瑞医药股份有限公司，规格为2 mL：4 mg，批准文号为国药准字H20143106）0.2 mg·kg-1用氯化钠注射液稀释至200 mL，初始剂量3 mL，背景剂量2 mL·h-1，单次自控镇痛（PCA）剂量3 mL，锁定时间20 min。BQ组除上述PCIA外，在超声引导下行双侧前路QLB，将便携式超声仪（M-Turbo型，Sonosite公司）低频探头放置于肋缘和髂嵴之间的腋中线处扫描，识别腰方肌在腰椎横突上方、腰大肌与竖脊肌分别在腰椎横突前后方，即“三叶草”征象，采用平面内技术将穿刺针的针尖穿至腰方肌和腰大肌之间的筋膜，每侧均分别给予0.25%罗哌卡因（AstraZeneca AB，规格为10 mL：75 mg，进口药品注册证号为国药准字H20140764）20 mL。若视觉模拟量表（VAS）评分>3分，单次PCA后仍存在明显疼痛者，给予曲马多50 mg静注补救镇痛。
观察指标
采用VAS与Bruggrmann舒适度量表（Bruggr-mann comfort scale，BCS）［6］评估患者术后2、6、12、24和48 h的镇痛效果，VAS评分为0~10分，评分越高表明疼痛程度越高；BCS评分为0~4分，评分越高表明舒适度越佳。于手术前和术后24h抽取外周静脉血，采用酶联免疫吸附（ELISA）法测定血清白细胞介素（IL）-6、C反应蛋白 （CRP）及肿瘤坏死因子（TNF）-α的浓度。记录患者术后首次肛门排气时间、进流质食物时间、下床活动时间及住院时间。患者出院时评价住院期间满意度，满分100分［7］。记录术后48 h内布托啡诺的消耗量及补救镇痛率。观察术后48 h内恶心呕吐发生率及QLB相关并发症如局麻药中毒、穿刺部位血肿、感染、腹腔脏器损伤等的发生情况。
统计学方法
采用SPSS20.0软件对数据进行统计学分析。计量资料以均数±标准差表示，组间比较采用t检验。计数资料以例数和百分率（%）表示，组间比较采用χ2检验或Fisher确切概率检验。P<0.05为差异有显著意义。
结 果
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术后镇痛情况
术后2、6、12、24 h，与B组比较，BQ组的VAS评分显著降低（P<0.05），BCS评分显著升高（P<0.05）；2组术后48h的VAS和BCS评分比较均无显著差异（P>0.05）。见表2。
IL-6、TNF-α和CRP水平
术前，2组IL-6、TNF-α和CRP水平比较无显著差异（P>0.05）。术后24 h，2组IL-6、TNF-α和CRP水平均较术前显著升高（P<0.05），而BQ组水平显著低于B组（P<0.05）。见表3。
术后康复情况和满意度
术后BQ组肛门排气、进流质食物、下床活动时间分别为（18.1±2.0）、（33.8±5.2）、（22.1±2.5）h，住院时间为（8.1±0.2）d，均短于B组［（23.9±1.9）、（37.8±6.6）、（28.2±3.6）h，（10.3±0.4）d，P<0.05］，差异均有显著意义（P<0.05）。BQ组住院满意度评分为（96.4±1.6）分，显著高于B组［（85.3±4.8）分，P<0.05］。
药物用量和不良反应
术后48 h内BQ组和B组布托啡诺消耗量分别为 （7.42±1.06）和（10.54±1.12）mg，补救镇痛率分别为7% （2/30）和30%（9/30），BQ组布托啡诺消耗量及补救镇痛率均显著低于B组（P<0.05）。术后48 h内， BQ组、B组发生恶心呕吐分别为2例（7%）、7例（23%），恶心呕吐发生率BQ组显著低于B组（P<0.05）。2组均无严重不良反应发生，BQ组QLB操作均顺利，未出现QLB相关并发症。
讨 论
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术后疼痛仍是影响腹腔镜结直肠癌根治术患者快速康复的重要因素［1, 2］，故术后镇痛很重要，而结直肠癌患者多年龄较大，对阿片类药物更敏感,易发生呼吸抑制等严重不良事件［8］。布托啡诺主要激动阿片κ受体，内脏镇痛效果好，对呼吸影响小［9］。QLB按穿刺注射药物靶点分为前路、后路及外路，前路注射药液可扩散至胸腰椎椎旁间隙，阻滞平面达T7~L2，对腹壁及内脏疼痛可产生良好镇痛效应［10, 11］，故本研究采用了前路QLB。本研究BQ组患者应用布托啡诺PCIA联合前路QLB术后镇痛，发现其术后2~24 h各观察时点的VAS评分均低于B组患者、 BCS评分均高于B组患者，说明与单纯布托啡诺PCIA比较，布托啡诺联合QLB可产生更好的术后镇痛效果，机制可能是在持续布托啡诺静脉镇痛下κ受体激活，与QLB产生协同作用，从而进一步控制了内脏疼痛。此外，BCS评分主要反映患者术后疼痛状况与舒适度，BQ组患者术后更佳的舒适度也为其早期的下床活动创造了良好的条件，可助力肠道功能尽快恢复［6］，这也是BQ组患者术后肛门排气时间缩短的原因之一。
手术创伤及术后疼痛可触发机体应激反应，产生大量炎症因子，炎症因子水平可间接反映机体康复状态［12］。有研究表明，QLB可有效减轻应激反应，减少并发症［13］。本研究中术后24 h，2组IL-6、TNF-α和CRP水平均高于术前，且BQ组低于B组，说明与单纯布托啡诺PCIA比较，布托啡诺联合QLB镇痛可更好地控制腹腔镜结直肠癌根治术患者术后应激反应，从而减少炎症因子释放。
良好的术后镇痛可有效降低术后不良事件发生，提高患者满意度［14］。术后恶心呕吐是术后镇痛最常见的并发症［15］，本研究中BQ组术后恶心呕吐发生率明显低于B组，考虑其原因是联合QLB减少了布托啡诺及补救镇痛药物的用量。术后肠道恢复、早期活动、早期引流管拔除等均有助于腹腔镜结直肠癌根治术患者术后快速康复［16, 17］。本研究BQ组术后肛门排气、进流质食物、下床活动时间及住院时间均明显短于B组，住院满意度评分也明显高于B组，说明布托啡诺联合QLB镇痛能更快恢复患者的胃肠蠕动，增强患者下床活动意愿，促进更早的术后康复训练，最终缩短住院时间，提高了患者的住院满意度。
综上所述，布托啡诺联合QLB用于腹腔镜结直肠癌根治术患者，可有效增强术后镇痛效果，减轻机体炎症反应，有利于患者早期康复。但本研究只观察了患者术后早期康复情况，未对出院后康复数据进一步追踪，且本研究为单中心试验、样本量较少，布托啡诺联合QLB的长期、确切效果还需大样本、多中心研究进一步论证。
基金
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  • 浙江省医学会临床科研基金(2021ZYC-A90)
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2024年第43卷第5期
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doi: 10.14109/j.cnki.xyylc.2024.05.10
  • 接收时间：2023-03-15
  • 首发时间：2026-03-20
  • 出版时间：2024-05-25
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  • 收稿日期：2023-03-15
  • 录用日期：2024-01-30
基金
浙江省医学会临床科研基金(2021ZYC-A90)
作者信息
    1.杭州市第九人民医院　麻醉科，浙江　杭州　311225
    2.浙江省人民医院　麻醉科，浙江　杭州310014

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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