超声引导下神经阻滞在腹部手术中的 应用现状与研究进展
Current Application and Research Progress of Ultrasound-Guided Nerve Block in Abdominal Surgery
DOI: 10.12677/acm.2026.1641586, PDF,   
作者: 张 翔*, 刘舒雨：西安医学院研究生处，陕西 西安；赵 玲#：西安医学院第一附属医院麻醉科，陕西 西安
关键词: 超声引导下神经阻滞；围术期镇痛；加速康复外科；Ultrasound-Guided Nerve Block； Perioperative Analgesia； Enhanced Recovery after Surgery
摘要: 超声引导下神经阻滞技术作为区域麻醉的重要组成部分，在腹部手术围术期镇痛中发挥着重要的作用。超声引导神经阻滞技术能够清晰显示目标区域的神经及血管图像，提供精准、安全的镇痛方案，提高阻滞的成功率，有效减少阿片类药物消耗，促进患者术后康复，体现了多模式镇痛和加速康复外科的理念。本综述系统阐述了几种超声引导神经阻滞技术在超声图像中的超声解剖定位，操作要点以及在腹部手术中的应用现状。
Abstract: As an important component of regional anesthesia, ultrasound-guided nerve block technology plays a vital role in perioperative analgesia for abdominal surgery. This technology enables clear visualization of the nerve and vascular images in the target area, provides precise and safe analgesic regimens, improves the success rate of nerve block, effectively reduces opioid consumption, and promotes postoperative recovery in patients, which embodies the concepts of multimodal analgesia and enhanced recovery after surgery (ERAS). This review systematically elaborates on the ultrasonic anatomical localization on ultrasonic images, key operational points, and current application status of several ultrasound-guided nerve block techniques in abdominal surgery.
文章引用：张翔, 刘舒雨, 赵玲. 超声引导下神经阻滞在腹部手术中的 应用现状与研究进展[J]. 临床医学进展, 2026, 16(4): 3252-3260. https://doi.org/10.12677/acm.2026.1641586

参考文献

[1] Saleem, S.Z., Akhtar, S.M.M., Fareed, A., Shaik, A.A. and Asghar, M.S. (2025) Redefining Pain Management: Investigating the Efficacy and Safety of Erector Spinae Plane Block and Oblique Subcostal Transversus Abdominis Plane Block in Laparoscopic Cholecystectomy—A Meta Analysis of Randomized Controlled Trials. BMC Anesthesiology, 25, Article No. 182. [Google Scholar] [CrossRef] [PubMed]
[2] Beverly, A., Kaye, A.D., Ljungqvist, O. and Urman, R.D. (2017) Essential Elements of Multimodal Analgesia in Enhanced Recovery after Surgery (ERAS) Guidelines. Anesthesiology Clinics, 35, e115-e143. [Google Scholar] [CrossRef] [PubMed]
[3] Chen, Y.Y.K., Boden, K.A. and Schreiber, K.L. (2021) The Role of Regional Anaesthesia and Multimodal Analgesia in the Prevention of Chronic Postoperative Pain: A Narrative Review. Anaesthesia, 76, 8-17. [Google Scholar] [CrossRef] [PubMed]
[4] Slinchenkova, K., Lee, K., Choudhury, S., Sundarapandiyan, D. and Gritsenko, K. (2023) A Review of the Paravertebral Block: Benefits and Complications. Current Pain and Headache Reports, 27, 203-208. [Google Scholar] [CrossRef] [PubMed]
[5] El-Boghdadly, K., Madjdpour, C. and Chin, K.J. (2016) Thoracic Paravertebral Blocks in Abdominal Surgery—A Systematic Review of Randomized Controlled Trials. British Journal of Anaesthesia, 117, 297-308. [Google Scholar] [CrossRef] [PubMed]
[6] 朱肖萌, 范飒, 康磊, 等. 超声引导下胸椎旁神经阻滞复合全身麻醉对胸腔镜手术患者的影响及其可能机制[J]. 实用临床医药杂志, 2024, 28(14): 44-48+53.
[7] Li, L., Wang, J., Hu, T., Xu, J. and Huang, J. (2025) The Effect of Ultrasound-Guided Multipoint Thoracic Paravertebral Nerve Block in Metabolic and Bariatric Surgery (MBS): A Prospective Randomized Controlled Trial. Obesity Surgery, 35, 3471-3481. [Google Scholar] [CrossRef] [PubMed]
[8] Wubetu, P., Kasahun, B., Bati, T., Debalke, A., Dendir, G., Kedir, A., et al. (2025) Analgesic Effectiveness of Ultrasound-Guided Unilateral Erector Spine Block versus Paravertebral Block for Postoperative Management among Adult Patients Undergoing Upper Abdominal Surgery: A Prospective Cohort Study. Annals of Medicine & Surgery, 87, 2568-2575. [Google Scholar] [CrossRef] [PubMed]
[9] Carline, L., McLeod, G.A. and Lamb, C. (2016) A Cadaver Study Comparing Spread of Dye and Nerve Involvement after Three Different Quadratus Lumborum Blocks. British Journal of Anaesthesia, 117, 387-394. [Google Scholar] [CrossRef] [PubMed]
[10] 陈美萍, 陈志聪. 腰方肌阻滞临床应用的研究进展[J]. 临床麻醉学杂志, 2022, 38(3): 308-312.
[11] El‐Boghdadly, K., Desai, N., Halpern, S., Blake, L., Odor, P.M., Bampoe, S., et al. (2021) Quadratus Lumborum Block vs. Transversus Abdominis Plane Block for Caesarean Delivery: A Systematic Review and Network Meta‐Analysis. Anaesthesia, 76, 393-403. [Google Scholar] [CrossRef] [PubMed]
[12] 李刚, 张建欣. 超声引导下腰方肌阻滞对经腹直肠癌根治术后镇痛效果的影响[J]. 临床麻醉学杂志, 2017, 33(10): 987-990.
[13] 李纯青. 腰方肌阻滞的临床应用进展[J]. 临床麻醉学杂志, 2018, 34(6): 616-619.
[14] 王丽薇, 敦元莉, 姚瑶, 等. 后入路腰方肌阻滞在腹腔镜子宫肌瘤剔除术中的应用[J]. 中国微创外科杂志, 2025, 31(2): 75-80.
[15] 胡婷婷, 张菁. 腰方肌阻滞复合依托咪酯麻醉对老年结直肠癌手术患者苏醒质量和肠道屏障功能的影响[J]. 实用医学杂志, 2025, 41(19): 2979-2984.
[16] Rytel, H., Rashid, B., Kaczmarski, P., Kaczmarski, M., Cheyne, I. and Mikaszewska-Sokolewicz, M. (2025) Quadratus Lumborum Block: The New Gold Standard in Abdominal Analgesia? Cureus, 17, e88051. [Google Scholar] [CrossRef] [PubMed]
[17] Tran, D.Q., Bravo, D., Leurcharusmee, P. and Neal, J.M. (2019) Transversus Abdominis Plane Block: A Narrative Review. Anesthesiology, 131, 1166-1190. [Google Scholar] [CrossRef] [PubMed]
[18] Liu, L., Xie, Y., Zhang, W. and Chai, X. (2018) Effect of Transversus Abdominis Plane Block on Postoperative Pain after Colorectal Surgery: A Meta-Analysis of Randomized Controlled Trials. Medical Principles and Practice, 27, 158-165. [Google Scholar] [CrossRef] [PubMed]
[19] Johns, N., O’Neill, S., Ventham, N.T., Barron, F., Brady, R.R. and Daniel, T. (2012) Clinical Effectiveness of Transversus Abdominis Plane (TAP) Block in Abdominal Surgery: A Systematic Review and Meta‐Analysis. Colorectal Disease, 14, e635-e642. [Google Scholar] [CrossRef] [PubMed]
[20] Garo, M.L., Ruggiero, A., di Folco, M., Costa, F., Migliorelli, S., Pascarella, G., et al. (2025) Transversus Abdominis Plane Block versus Thoracic Epidural Analgesia for Laparoscopic Surgery: Implication for ERAS Protocols. A Systematic Review and Meta-Analysis. Minerva Anestesiologica, 91, 1064-1071. [Google Scholar] [CrossRef] 
[21] Forero, M., Adhikary, S.D., Lopez, H., Tsui, C. and Chin, K.J. (2016) The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Regional Anesthesia and Pain Medicine, 41, 621-627. [Google Scholar] [CrossRef] [PubMed]
[22] Ivanusic, J., Konishi, Y. and Barrington, M.J. (2018) A Cadaveric Study Investigating the Mechanism of Action of Erector Spinae Blockade. Regional Anesthesia and Pain Medicine, 43, 567-571. [Google Scholar] [CrossRef] [PubMed]
[23] 吴健, 杨艳兵, 董学义, 等. 超声引导下竖脊肌平面阻滞的临床应用进展[J]. 临床麻醉学杂志, 2019, 35(6): 604-607.
[24] Abdelhamid, B.M., Khaled, D., Mansour, M.A. and Hassan, M.M. (2020) Comparison between the Ultrasound-Guided Erector Spinae Block and the Subcostal Approach to the Transversus Abdominis Plane Block in Obese Patients Undergoing Sleeve Gastrectomy: A Randomized Controlled Trial. Minerva Anestesiologica, 86, 816-826. [Google Scholar] [CrossRef] [PubMed]
[25] Dinc, B., Aycan, I.O., Avanaz, A., et al. (2025) Erector Spinae Plane Block for Postoperative Analgesia in Laparoscopic Living-Donor Nephrectomy. Experimental and Clinical Transplantation, 23, 523-529.
[26] 刘金变, 单嘉琪, 严海, 等. 超声下腹直肌鞘阻滞在腹式全子宫切除术中的应用[J]. 临床麻醉学杂志, 2013, 29(7): 649-651.
[27] 刘明红, 于乐涛, 石军. 腹直肌鞘阻滞用于剖宫产术后镇痛效果观察及对产后抑郁发生的影响[J]. 蚌埠医学院学报, 2020, 45(8): 1072-1076.
[28] Kim, D., Bang, S., Chung, J., Lee, Y., Shin, H. and Park, Y. (2025) Comparison of Quadratus Lumborum Block and Rectus Sheath Block for Postoperative Analgesia in Single-Port Laparoscopic Adnexal Surgery: A Randomized Controlled Trial. Medicina, 61, Article 1084. [Google Scholar] [CrossRef] [PubMed]
[29] 刘松彬, 薛庆生, 张基, 等. 双侧腹横肌平面阻滞复合双侧腹直肌鞘阻滞在腹腔镜胆囊切除术中的应用[J]. 临床麻醉学杂志, 2016, 32(6): 550-554.
[30] 詹宇悦, 葛琼, 王超威, 等. 超声引导下横突间阻滞的临床应用进展[J]. 赣南医科大学学报, 2025, 45(10): 1017-1021.
[31] 王薇, 周淑敏, 黄真, 等. 术前腰方肌阻滞与横突间阻滞对妇科腹腔镜手术患者术后疼痛和早期恢复的影响[J]. 新疆医科大学学报, 2024, 47(5): 709-712+718.
[32] Chen, Q., Zhou, X., Wang, F., Zeng, Y., Qian, B. and Du, H. (2025) Intertransverse Process Block versus Subcostal Transversus Abdominis Plane Block in Patients Undergoing Laparoscopic Radical Gastrectomy: A Prospective Randomized Controlled Trial. BMC Anesthesiology, 25, Article No. 9. [Google Scholar] [CrossRef] [PubMed]

为你推荐