超声引导下2种神经阻滞方法在腹腔镜全子宫切除术中麻醉效果与安全性比较

doi:10.11958/20253133

天津医药 ›› 2026, Vol. 54 ›› Issue (3): 264-268.doi: 10.11958/20253133

超声引导下2种神经阻滞方法在腹腔镜全子宫切除术中麻醉效果与安全性比较

李佳¹(), 赵墨菊², 杨惠茹¹, 高丽峰³, 高月⁴, 李侃¹, 郭素娜³, 沈建军³

1 张家口市第一医院麻醉科（邮编075000）
2 透析室
3 妇产科
4 手术室

收稿日期:2025-10-13 修回日期:2025-11-17 出版日期:2026-03-15 发布日期:2026-03-17
作者简介:李佳（1984），男，主治医师，主要从事麻醉学方面研究。E-mail：lijia5761@163.com
基金资助:
河北省医学科学研究课题计划(20241628)

Comparison of anesthetic effect and safety of two nerve block methods under ultrasound guidance in laparoscopic total hysterectomy

LI Jia¹(), ZHAO Moju², YANG Huiru¹, GAO Lifeng³, GAO Yue⁴, LI Kan¹, GUO Suna³, SHEN Jianjun³

1 Department of Anesthesiology
2 Dialysis Room
3 Department of Obstetrics and Gynecology
4 Operating Room, Zhangjiakou First Hospital, Zhangjiakou 075000, China

Received:2025-10-13 Revised:2025-11-17 Published:2026-03-15 Online:2026-03-17

李佳, 赵墨菊, 杨惠茹, 高丽峰, 高月, 李侃, 郭素娜, 沈建军. 超声引导下2种神经阻滞方法在腹腔镜全子宫切除术中麻醉效果与安全性比较[J]. 天津医药, 2026, 54(3): 264-268.

LI Jia, ZHAO Moju, YANG Huiru, GAO Lifeng, GAO Yue, LI Kan, GUO Suna, SHEN Jianjun. Comparison of anesthetic effect and safety of two nerve block methods under ultrasound guidance in laparoscopic total hysterectomy[J]. Tianjin Medical Journal, 2026, 54(3): 264-268.

摘要/Abstract

摘要：

目的比较超声引导弓状韧带上腰方肌前侧阻滞与腹横肌平面阻滞（TAPB）在腹腔镜全子宫切除术中的麻醉效果与安全性。方法选取2020年10月—2023年10月在我院接受腹腔镜全子宫切除术治疗的120例患者，采用随机数字表法分为对照组与观察组。对照组术前在超声引导下行双侧TAPB，观察组术前在超声引导下行双侧弓状韧带上腰方肌前侧阻滞，2组术后均采用自控静脉镇痛（PCIA）干预。比较2组患者血流动力学、术中瑞芬太尼用量、术中丙泊酚用量、应激反应、疼痛视觉模拟（VAS）评分、镇痛效果及术后康复指标。结果 2组插管时（T1）、拔管时（T2）心率、平均动脉压均较入室时（T0）时升高，且观察组低于对照组（P<0.05）。观察组术中瑞芬太尼用量少于对照组，丙泊酚用量与对照组比较，差异无统计学意义（P>0.05）。2组术毕、术后24 h时肾上腺素（AE）、多巴胺（DA）、去甲肾上腺素（NE）均较术前升高，但观察组术毕、术后24 h时低于对照组（P<0.05）。观察组静息与运动时术后6、12、24、48 h时疼痛VAS评分低于对照组，镇痛泵按压次数、补救镇痛率、下床活动时间、首次排气时间少于对照组（P<0.05）。结论超声引导弓状韧带上腰方肌前侧阻滞用于腹腔镜全子宫切除中可稳定血流动力学，减轻机体应激反应，镇痛效果好。

关键词: 子宫切除术, 腹腔镜检查, 神经传导阻滞, 超声引导弓状韧带上腰方肌前侧阻滞, 腹横肌平面阻滞

Abstract:

Objective To compare the efficacy and safety of ultrasound-guided anterolateral lumbar flexus block over the arcuate ligament with transversus abdominis plane block (TAPB) for anesthesia in laparoscopic total hysterectomy. Methods A total of 120 patients who underwent laparoscopic total hysterectomy at our hospital between October 2020 and October 2023 were selected and randomly assigned to two groups using a random number table. The control group underwent TAPB under ultrasound guidance preoperatively, while the observation group received bilateral pre-quadratus lumborum block over the arcuate ligament under ultrasound guidance. Both groups received patient-controlled intravenous analgesia (PCIA) postoperatively. The following parameters were compared between the two groups, including hemodynamic status, intraoperative remifentanil consumption, intraoperative propofol consumption, stress response, visual analog scale (VAS) scores, analgesic efficacy and postoperative recovery indicators. Results The heart rate and mean arterial pressure at intubation (T1) and extubation (T2) were higher in both groups than those at admission (T0), and those were lower in the observation group than the control group (P<0.05). The dosage of remifentanil was less during surgery in the observation group than those of the control group, while there was no significant difference in propofol usage between the two groups (P>0.05). At the end of surgery and 24 hours postoperatively, levels of epinephrine (AE), dopamine (DA) and norepinephrine (NE) were elevated in both groups compared to preoperative levels. However, these levels were lower in the observation group than those in the control group at both time points (P<0.05). The VAS scores of pain at rest and during exercise at 6, 12, 24 and 48 hours after surgery were lower in the observation group than those in the control group. The number of compressions of the analgesic pump, the rate of remedial analgesia, the time to get out of bed and move around, and the time to first exhaust were less in the observation group than those in the control group (P<0.05). Conclusion Ultrasound-guided anterolateral block of the superior lumbar quadratus muscle over the arcuate ligament for use in laparoscopic total hysterectomy can stabilize haemodynamics, reduce body stress response and provide good analgesia.

Key words: hysterectomy, laparoscopy, nerve block, ultrasound-guided anterolateral lumbar flexus block on the arcuate ligament, transversus abdominis plane block

中图分类号:

R614.4

图/表 6

参考文献 21

[1]	O'HANLAN K A, EMENEY P L, FRANK M I, et al. Total laparoscopic hysterectomy:making it safe and successful for obese patients[J]. JSLS, 2021, 25(2):e2020.00087. doi:10.4293/JSLS.2020.00087.
[2]	VARGAS M, ARORA Y, ALEJANDRO BUENO M, et al. Adverse outcomes related to morcellation in total laparoscopic hysterectomy[J]. Eur J Obstet Gynecol Reprod Biol, 2024, 294:231-237. doi:10.1016/j.ejogrb.2024.01.031.
[3]	CHAKRABORTY N, RHODES S, LUCHRISTT D, et al. Is total laparoscopic hysterectomy with longer operative time associated with a decreased benefit compared with total abdominal hysterectomy?[J]. Am J Obstet Gynecol, 2023, 228(2):205.e1-205.e12. doi:10.1016/j.ajog.2022.09.042.
[4]	孙艳波, 罗静枝, 王晶武, 等. 腹腔镜下子宫切除术患者采用不同全身麻醉方式对其麻醉苏醒质量的影响及危险因素分析[J]. 中国性科学, 2024, 33(6):110-114.
	SUN Y B, LUO J Z, WANG J W, et al. Influence of different general anesthesia on the quality of anesthesia recovery and its risk factors in patients with laparoscopic hysterectomy[J]. Chinese Journal of Sexology, 2024, 33(6):110-114. doi:10.3969/j.issn.1672-1993.2024.06.027.
[5]	ALIMKHANOVA G, SYZDYKBAYEV M, ASHZHANOV R, et al. The transversus abdominis plane block as a method of multimodal opioid-sparing postoperative analgesia:a narrative review[J]. Georgian Med News, 2025,(364/365):188-194.
[6]	GU B, ZHOU H, LIAN Y, et al. Ultrasound-guided anterior quadratus lumborum block at lateral supra-arcuate ligament vs thoracic epidural analgesia after open liver surgery:a randomized, controlled, noninferiority trial[J]. J Am Coll Surg, 2022, 235(6):871-878. doi:10.1097/XCS.0000000000000354.
[7]	PEDROSA E, SILVA M, LOBO A, et al. Is the ASA classification universal?[J]. Turk J Anaesthesiol Reanim, 2021, 49(4):298-303. doi:10.5152/TJAR.2021.103.
[8]	SHAFSHAK T S, ELNEMR R. The visual analogue scale versus numerical rating scale in measuring pain severity and predicting disability in low back pain[J]. J Clin Rheumatol, 2021, 27(7):282-285. doi:10.1097/RHU.0000000000001320.
[9]	王彩萍, 韩晓彤, 黎明, 等. 调节CO₂气腹压力在腹腔镜全子宫切除术中的应用研究[J]. 蚌埠医学院学报, 2022, 47(10):1477-1479.
	WANG C P, HAN X T, LI M, et al. Application research on the adjustment of CO₂ pneumoperitoneum pressure in total laparoscopic hysterectomy[J]. Journal of Bengbu Medical College, 2022, 47 (10):1477-1479. doi:10.13898/j.cnki.issn.1000-2200.2022.10.033.
[10]	王红利, 王导利, 林换弟. 经脐单孔腹腔镜盆腔淋巴结切除联合经阴道广泛子宫切除术治疗早期宫颈癌的临床疗效评价[J]. 临床和实验医学杂志, 2024, 23(7):741-745.
	WANG H L, WANG D L, LIN H D. Evaluation of the efficacy of transumbilical single-port laparoscopic pelvic lymph node resection combined with extensive vaginal hysterectomy in the treatment of early cervical cancer[J]. Journal of Clinical and Experimental Medicine, 2024, 23(7):741-745 doi:10.3969/j.issn.1671-4695.2024.07.018.
[11]	张伟娜. 无气腹与气腹腹腔镜辅助阴式全子宫切除术的效果比较[J]. 中国民康医学, 2022, 34(8):143-146.
	ZHANG W N. Comparison of effects of laparoscopic assisted transvaginal hysterectomy with and without pneumoperitoneum[J]. Chinese Journal of Traditional Chinese Medicine, 2022, 34(8):143-146. doi:10.3969/j.issn.1672-0369.2022.08.042.
[12]	刘超, 吉林, 刘存明. 腹腔镜结直肠手术中气管导管套囊压力控制对术中血流动力学及术后咽喉痛的影响[J]. 南京医科大学学报(自然科学版), 2024, 44(8):1100-1105.
	LIU C, JI L, LIU C M. Effect of tracheal tube cuff pressure control on intraoperative hemodynamics and postoperative sore throat during laparoscopic colorectal surgery[J]. Journal of Nanjing Medical University (Natural Science Edition), 2024, 44(8):1100-1105. doi:10.7655/NYDXBNSN240142.
[13]	李如意, 孙艳, 嵇富海. 不同潮气量复合基于EIT的个体化PEEP对妇科腹腔镜手术患者肺通气分布的影响[J]. 国际麻醉学与复苏杂志, 2025, 46(4):366-371.
	LI R Y, SUN Y, JI F H. The effect of individualized PEEP based on EIT combined with different tidal volumes on lung ventilation distribution in gynecological laparoscopic surgery patients[J]. International Journal of Anesthesiology and Resuscitation, 2025, 46(4):366-371. doi:10.3760/cma.j.cn321761-20241214-01242.
[14]	赵嫣红, 蒋海卿, 许媛媛, 等. 艾司氯胺酮联合丙泊酚对腹腔镜全子宫切除术患者血清炎症因子和应激反应的影响[J]. 现代生物医学进展, 2023, 23(20):3836-3840,3864.
	ZHAO Y H, JIANG H Q, XU Y Y, et al. Effect of esketamine combined with propofol on serum inflammatory factors and stress response in patients undergoing laparoscopic total hysterectomy[J]. Advances in Modern Biomedicine, 2023, 23(20):3836-3840,3864. doi:10.13241/j.cnki.pmb.2023.20.007.
[15]	张丽娟, 张瑾萱, 苏涛. 全麻腹腔镜全子宫切除术患者麻醉苏醒期并发低氧血症相关因素及护理对策[J]. 中国计划生育学杂志, 2024, 32(11):2635-2639,2644.
	ZHANG L J, ZHANG J X, SU T. Related factors and the nursing strategies of the hypoxemia during anesthesia recovery period of patients after laparoscopic total hysterectomy under general anesthesia[J]. Chinese Journal of Family Planning, 2024, 32(11):2635-2639,2644. doi:10.3969/j.issn.1004-8189.2024.11.035.
[16]	范菁一, 耿志宇, 王东信. 遗传性凝血因子Ⅴ缺乏症患者行腹腔镜全子宫切除术麻醉管理1例及文献回顾[J]. 国际麻醉学与复苏杂志, 2025, 46(2):178-182.
	FAN J Y, GENG Z Y, WANG D X. Anesthetic management of a patient with hereditary factor Ⅴ deficiency undergoing laparoscopic total hysterectomy:a case report and literature review[J]. International Journal of Anesthesiology and Resuscitation, 2025, 46(2):178-182. doi:10.3760/cma.j.cn321761-20240303-01210.
[17]	秦俊, 董翔宇. 超声引导下弓状韧带上腰方肌前侧阻滞复合全麻用于腹腔镜全子宫切除术效果[J]. 中国计划生育学杂志, 2024, 32(6):1341-1344,1349.
	QIN J, DONG X Y. Effect of ultrasound-guided anterior block of superior arcuate ligament quadrate musculi lumbosum combined with general anesthesia during laparoscopic total hysterectomy[J]. Chinese Journal of Family Planning, 2024, 32(6):1341-1344,1349. doi:10.3969/j.issn.1004-8189.2024.06.024.
[18]	李响, 贾梦醒, 高震南, 等. 两种不同入路腰方肌阻滞在腹腔镜直肠癌根治术中的应用[J]. 实用医学杂志, 2023, 39(10):1258-1262.
	LI X, JIA M X, GAO Z N, et al. Application of lumbar quadratus block via superior arcuate ligament or posterior approach in rectal cancer surgery[J]. Journal of Practical Medicine, 2023, 39(10):1258-1262. doi:10.3969/j.issn.1006-5725.2023.10.012.
[19]	PRABHAKAR P, GANAPATHI H P, SURESH V, et al. Surgeon administered transversus abdominis plane block:anatomic principles and technique[J]. J Robot Surg, 2023, 17(4):1193-1205. doi:10.1007/s11701-023-01535-9.
[20]	余莲雅, 张静, 郑蓓, 等. 外侧弓状韧带上腰方肌前侧阻滞与腹横肌平面阻滞在腹腔镜下全子宫切除术术后恢复质量的比较[J]. 医学研究杂志, 2023, 52(8):140-143,139.
	YU L Y, ZHANG J, ZHENG B, et al. Comparison of recovery quality between ultrasound-guided anterior quadratus lumborum block at the lateral supra-arcuate ligament and transversus abdominis plane block after laparoscopic total hytetomy[J]. Journal of Medical Research, 2023, 52(8):140-143,139. doi:10.11969/j.issn.1673-548X.2023.08.028.
[21]	MAO Y, ZHAO W, HAO M, et al. Ultrasound-guided quadratus lumborum block at the lateral supra-arcuate ligament versus subcostal transversus abdominis plane block for postoperative analgesia following open hepatectomy:a randomized controlled trial[J]. J Pain Res, 2023, 16:1429-1440. doi:10.2147/JPR.S404810.

组别	年龄/岁	入院诊断		ASA分级
组别	年龄/岁	子宫肌瘤	子宫肌腺病	Ⅰ级	Ⅱ级
对照组	46.56±5.62	38（63.33）	22（36.67）	25（41.67）	35（58.33）
观察组	47.14±5.55	40（66.67）	20（33.33）	29（48.33）	31（51.67）
t或χ²	0.569	0.147		0.539

组别	年龄/岁	入院诊断		ASA分级
组别	年龄/岁	子宫肌瘤	子宫肌腺病	Ⅰ级	Ⅱ级
对照组	46.56±5.62	38（63.33）	22（36.67）	25（41.67）	35（58.33）
观察组	47.14±5.55	40（66.67）	20（33.33）	29（48.33）	31（51.67）
t或χ²	0.569	0.147		0.539

组别	心率/（次/min）
组别	T0	T1		T2		T3
对照组	78.95±8.54	97.19±9.71^a		95.56±7.33^a		80.12±9.04^b
观察组	79.01±7.93	88.74±7.83^a		87.05±8.04^a		78.98±7.83^b
t	0.040	5.247^＊＊		6.059^＊＊		0.738
F_组间/F_时间/F_交互	34.125^＊＊/96.926^＊＊/9.240^＊＊
组别	平均动脉压/mmHg
组别	T0	T1	T2		T3
对照组	89.85±6.75	98.86±5.88^a	99.41±6.03^a		90.10±6.08^b
观察组	90.11±5.93	95.57±5.73^a	94.30±5.46^a		89.63±5.75^b
t	0.224	3.104^＊＊	4.866^＊＊		0.435
F_组间/F_时间/F_交互	13.805^＊＊/52.551^＊＊/4.860^＊＊

组别	心率/（次/min）
组别	T0	T1		T2		T3
对照组	78.95±8.54	97.19±9.71^a		95.56±7.33^a		80.12±9.04^b
观察组	79.01±7.93	88.74±7.83^a		87.05±8.04^a		78.98±7.83^b
t	0.040	5.247^＊＊		6.059^＊＊		0.738
F_组间/F_时间/F_交互	34.125^＊＊/96.926^＊＊/9.240^＊＊
组别	平均动脉压/mmHg
组别	T0	T1	T2		T3
对照组	89.85±6.75	98.86±5.88^a	99.41±6.03^a		90.10±6.08^b
观察组	90.11±5.93	95.57±5.73^a	94.30±5.46^a		89.63±5.75^b
t	0.224	3.104^＊＊	4.866^＊＊		0.435
F_组间/F_时间/F_交互	13.805^＊＊/52.551^＊＊/4.860^＊＊

组别	丙泊酚用量	瑞芬太尼用量
对照组	248.56±12.03	1.50±0.05
观察组	245.41±13.28	1.27±0.04
t	1.362	27.823^＊＊

超声引导下2种神经阻滞方法在腹腔镜全子宫切除术中麻醉效果与安全性比较

Comparison of anesthetic effect and safety of two nerve block methods under ultrasound guidance in laparoscopic total hysterectomy

引用本文

RichHTML

PDF (PC)

可视化

摘要/Abstract

使用本文

图/表 6

参考文献 21

相关文章 15

编辑推荐

Metrics

本文评价

组别		AE
组别		术前		术毕		术后24 h
对照组		38.45±6.52		54.52±7.96^a		87.85±12.14^ab
观察组		39.14±6.88		46.33±6.55^a		68.52±10.09^ab
t		0.564		6.154^＊＊		9.485^＊＊
F_组间/F_时间/F_交互		108.826^＊＊/605.138^＊＊/37.171^＊＊
组别	DA
组别	术前		术毕		术后24 h
对照组	75.98±9.64		98.85±13.54^a		123.02±19.98^ab
观察组	76.04±11.47		90.14±11.44^a		108.87±16.43^ab
t	0.031		3.806^＊＊		4.237^＊＊
F_组间/F_时间/F_交互	29.723^＊＊/252.491^＊＊/8.123^＊＊
组别		NE
组别		术前	术毕				术后24 h
对照组		135.65±10.47	175.52±18.82^a				217.55±16.38^ab
观察组		134.77±13.09	162.23±16.43^a				190.40±14.73^ab
t		0.407	4.121^＊＊				9.547^＊＊
F_组间/F_时间/F_交互		91.966^＊＊/616.836^＊＊/22.499^＊＊

组别	静息时
组别	术后6 h		术后12 h		术后24 h		术后48 h
对照组	2.93±0.46		2.78±0.51		1.81±0.26		0.77±0.21
观察组	2.40±0.38		2.16±0.30		1.37±0.25		0.39±0.20
t	6.881^＊＊		8.117^＊＊		9.449^＊＊		10.150^＊＊
F_组间/F_时间/F_交互	280.783^＊＊/868.039^＊＊/102.499^＊＊
组别		运动时
组别		术后6 h		术后12 h		术后24 h		术后48 h
对照组		3.52±0.46		3.18±0.44		2.10±0.38		0.91±0.24
观察组		3.05±0.37		2.72±0.26		1.59±0.32		0.55±0.20
t		6.167^＊＊		6.972^＊＊		7.952^＊＊		8.926^＊＊
F_组间/F_时间/F_交互		204.749^＊＊/1 354.695^＊＊/47.987^＊＊

组别	镇痛泵按压次数/次	补救镇痛率	下床活动时间/h	首次排气时间/h
对照组	20.48±3.41	21（35.00）	15.41±3.23	29.45±5.65
观察组	12.24±2.06	7（11.67）	13.05±2.16	24.10±4.17
t或χ²	16.021^＊＊	9.130^＊＊	4.705^＊＊	5.901^＊＊

[1]	赵丽, 马秀丽, 刘毅, 朱毅. 全麻下腹腔镜胃癌根治术后谵妄发生的危险因素分析[J]. 天津医药, 2026, 54(3): 259-264.
[2]	李文娣, 王焕玲, 杨学伟, 谢淑华, 张军. 超声引导下喉上神经阻滞在保留自主呼吸气管插管中的应用效果[J]. 天津医药, 2026, 54(2): 179-183.
[3]	刘颖, 葛东建, 朱炫姿, 向雯, 耿明悦, 程伟. 经皮耳迷走神经刺激对妇科腹腔镜手术患者术后胃肠功能恢复的影响[J]. 天津医药, 2025, 53(2): 189-193.
[4]	万方鑫, 刘宾, 张皓程, 张昌文, 李宝玉. 腹腔镜疝囊高位结扎联合IPOM与局麻李金斯坦修补术治疗男性全膀胱切除术后腹股沟疝[J]. 天津医药, 2025, 53(10): 1033-1036.
[5]	韩正怡, 李锐, 陈齐, 王家友, 盛奎, 宋洁, 张野. 收肌管阻滞联合全麻对老年全膝关节置换术患者术后疼痛和认知功能的影响[J]. 天津医药, 2024, 52(5): 523-527.
[6]	蒋玲玲, 李云, 盛奎, 张丽丽, 胡阳, 张野. 外侧弓状韧带上腰方肌与腹横肌平面阻滞对腹腔镜肝脏部分切除术后镇痛效果的研究[J]. 天津医药, 2024, 52(3): 302-305.
[7]	钟晓倩, 孙高悦, 张倩倩, 李云. 驱动压导向的个体化呼气末正压通气对行腹腔镜胃癌根治术老年患者的肺保护作用[J]. 天津医药, 2024, 52(2): 188-192.
[8]	杨先瑞, 康绍叁, 郭琪, 赵妍, 李刚, 韩瑞发, 蔡启亮. 加速康复外科在肾上腺肿瘤微创手术中的应用研究[J]. 天津医药, 2024, 52(10): 1038-1040.
[9]	吴克义, 黄勇, 许成浩, 马天鸣, 代飞彪, 李雪, 唐朝亮. 全麻联合胸椎旁神经阻滞对肺癌手术患者术后镇痛和肺部感染的影响[J]. 天津医药, 2023, 51(6): 648-652.
[10]	高威, 余晨, 左伟, 吴公景, 李清智, 刘翔. 经脐单部位腹腔镜手术联合术后早期肠内营养在先天性十二指肠梗阻快速康复中的应用效果[J]. 天津医药, 2023, 51(5): 530-534.
[11]	王丹, 赵丽霞, 彭雅琪, 原大江. 不同剂量地塞米松用于超声引导下罗哌卡因髂筋膜阻滞的效果观察[J]. 天津医药, 2022, 50(8): 878-882.
[12]	刘旺敏, 张墨. 混合现实技术用于机器人辅助腹腔镜肾部分切除术的研究进展[J]. 天津医药, 2022, 50(4): 444-448.
[13]	范琳峰, 曾祥福, 曾翔辉, 邓伟. 经脐单孔+1孔与传统腹腔镜结直肠癌根治术的安全性及可行性对比研究[J]. 天津医药, 2021, 49(12): 1307-1310.
[14]	孙熠, 王海云, 华伟△, 赵茗姝. 罗哌卡因用于超声引导老年腹股沟疝患者髂腹下、髂腹股沟联合生殖股神经阻滞的EC50及EC95[J]. 天津医药, 2020, 48(7): 654-656.
[15]	胡光俊, 李莉, 宋晓阳, 黎笔熙, 甘国胜. 2.5 mg和5 mg地塞米松对罗哌卡因臂丛阻滞效果的影响[J]. 天津医药, 2020, 48(10): 997-1000.