目的 探讨超声引导下弓状韧带上腰方肌阻滞与竖脊肌阻滞对后路腰椎手术患者术后早期康复的影响。 方法 选择择期行后路腰椎手术患者93例，性别不限，年龄25 ~ 70岁， 体质量指数（BMI）18 ~ 30 kg/m2， ASA分级Ⅱ~Ⅲ级，随机分为3组。Q组超声引导下弓状韧带上腰方肌阻滞联合全麻，E组超声引导下竖脊肌阻滞联合全麻，N 组单纯全麻。3组患者术后均采用静脉自控镇痛泵（PCIA）。记录3组患者苏醒时、术后6、12、24 h的Richmond躁动-镇静（RASS）评分和伯格曼舒适度量表（BCS）评分；记录PCA使用结束Likert量表评分；记录术前1 d和术后1、3 d的匹兹堡睡眠质量指数（PSQI）及术后早期康复质量指标（QoR-15）；记录术后苏醒时间、拔管时间、出复苏室时间、首次肛门排气时间、首次下床时间、术后住院时间及术后48 h内不良反应发生情况。 结果 （1）与N组比较，Q组术后各时点RASS评分较低且BCS评分较高，PCA使用结束后Likert评分1级比例更高（P < 0.05）；E组苏醒时、术后24 h RASS评分较N组低，苏醒时、术后6、24 h BCS评分较N组高（P < 0.05）；与E组比较，Q组术后12 h RASS评分较低且BCS评分较高（P < 0.05）。（2）Q组与N组比较，术后1、3 d PSQI评分较低且QoR-15评分较高（P < 0.05）；而E组与N组比较，PSQI评分差异无统计学意义（P > 0.05），E组仅在术后1 d QoR-15评分较N组高（P < 0.05）。（3）与N组比较，Q组苏醒时间、拔管时间、出复苏室时间、首次肛门排气时间及首次下床时间均显著缩短（P < 0.05）；E组仅首次肛门排气时间短于N组（P < 0.05）； Q组出复苏室时间较E组缩短（P < 0.01）。（4）三组患者不良反应发生率差异无统计学意义（P > 0.05）。 结论 超声引导下弓状韧带上腰方肌阻滞和竖脊肌阻滞均能有效改善术后镇痛效果与早期康复质量，但弓状韧带上腰方肌阻滞在提升患者舒适度和镇痛满意度、促进睡眠质量及加速术后整体恢复方面更具优势。

Objective To compare the effects of quadratus lumborum block at the lateral supra?arcuate ligament （QLB?LSAL） and erector spinae plane block （ESPB） on early postoperative recovery in patients undergoing posterior lumbar surgery. Methods Ninety?three patients， aged 25 ~ 70 years， BMI 18 ~ 30 kg/m2 and ASA physical status Ⅱ or Ⅲ and scheduled for posterior lumbar surgery， were randomly divided into QLB?LSAL combined with general anesthesia （Group Q）， ESPB combined with general anesthesia （Group E）， and general anesthesia alone （Group N）. Postoperatively， all groups received patient?controlled intravenous analgesia （PCIA）. The following parameters were recorded： the scores of Richmond Agitation?Sedation Scale （RASS） and Bergman Comfort Scale （BCS） at awakening， 6 h， 12 h， and 24 h postoperatively； Likert scale score at PCIA cessation； the scores of Pittsburgh Sleep Quality Index （PSQI） and Early Postoperative Quality of Recovery?15 （QoR?15） at 1 day preoperatively and 1 day and 3 days postoperatively. Additionally， postoperative recovery indicators including awakening time， extubation time， PACU stay time， time to first anal exhaust， time to first ambulation， postoperative hospital stay， and adverse reactions within 48 h were recorded. Results （1）Compared with group N， group Q showed significantly lower RASS scores and higher BCS scores at all postoperative time points， with a higher proportion of Likert score grade 1 after PCIA cessation （P < 0.05）. Group E had lower RASS scores at emergence and 24 h postoperatively， and higher BCS scores at emergence， 6 h， and 24 h postoperatively while compared to group N （P < 0.05）. At 12h postoperatively， group Q demonstrated lower RASS scores and higher BCS scores than group E （P < 0.05）. （2） Compared with Group N， group Q exhibited lower PSQI scores and higher QoR?15 scores at 1 and 3 days postoperatively （P < 0.05）. No statistically significant difference in PSQI scores was observed between group E and N （P > 0.05）， while group E had higher QoR?15 score than group N only at 1 day postoperatively （P < 0.05）. Both at 1 and 3 days postoperatively， group Q had lower PSQI scores and higher QoR?15 scores than group E （P < 0.05）. （3） Postoperative awakening time， extubation time， PACU stay time， time to first anal exhaust and time to first ambulation were significantly shorter in group Q than those in group N （P < 0.05）. Group E only showed shorter time to first anal exhaust compared to group N （P < 0.05）. Furthermore， group Q had a significantly shorter PACU stay time than group E （P < 0.01）. （4） There was no statistically significant difference in the incidence of adverse reactions among the three groups of patients. （P > 0.05）. Conclusions Both QLB?LSAL and ESPB effectively improve postoperative analgesia and early recovery quality. However， QLB?LSAL demonstrates advantages in enhancing patient comfort， analgesia satisfaction， sleep quality， and accelerating overall postoperative recovery.