超声引导下肋缘下腹横肌平面阻滞用于剖宫产手术后的镇痛效果  

Efficacy of ultrasound-guided subcostal transversus abdominis plane block for postoperative analgesia in patients undergoing caesarean section

作　　者：吕莹莹[1] 赵达强[1] 谢亚明[1] 张宇[1] 江伟[1] 

机构地区：[1]上海交通大学附属第六人民医院麻醉科,上海200233

出　　处：《上海医学》2014年第4期297-299,F0003,共4页Shanghai Medical Journal

摘　　要：目的观察超声引导下肋缘下腹横肌平面阻滞用于剖宫产手术后的镇痛效果。方法行择期剖宫产手术的患者50例,随机分入试验组和对照组,每组25例。两组患者术后均采用患者静脉自控镇痛。试验组患者术后在超声引导下于双侧肋缘下在腹内斜肌和腹横肌筋膜间注入0.375%罗哌卡因各15mL,对照组患者应用相同方法注入0.9%氯化钠溶液各15mL。应用疼痛视觉模拟评分(VAS评分)评估患者术后6、12、24和48h的镇痛效果。记录48h经静脉患者自控镇痛(PCA)的用药量,以及患者术后下床活动时间,观察有无并发症发生。结果术后6和12h,试验组的疼痛VAS评分显著低于对照组同时间点(P值均<0.05);两组间术后24和48h疼痛VAS评分的差异均无统计学意义(P值均>0.05)。试验组的平均下床活动时间显著短于对照组(P<0.05),平均PCA总用量显著少于对照组(P<0.05)。试验组中横切口(12例)与竖切口(13例)患者术后6和12h的疼痛VAS评分、PCA总用量的差异均无统计学意义(P值均>0.05)。试验组和对照组均未发生并发症。结论超声引导下肋缘下腹横肌平面阻滞用于剖宫产手术后的镇痛安全、有效。Objective To observe the postoperative analgetic effect of ultrasound-guided subcostal transversus abdominis plane block in patients undergoing caesarean section. Methods Fifty pregnant women scheduled for caesarean section were randomized into 2 groups （n = 25）. In experiment group, patients received subcostal transversus abdominis plane block （TAPB） guided by ultrasound with 0. 375% ropivacaine 15 mL each side after operation. Patients in control group received the same dose of physiological saline. The analgetic outcome was evaluated by visual analogue scale （VAS） at 6, 12, 24 and 48 hours after caesarean section. Drug consumption of patient controlled analgesia （PCA） was recorded 48 hours after the operation. Out-of-bed activity time and adverse reactions were also recorded. Results VAS scores at 6 and 12 hours after operation in the experiment group were significantly lower than those in the control group （both P〈O. 05）, while there was no significant difference in the VAS scores at 24 or 48 hours after operation between two groups （both P〉O. 05）. The out-of-bed activity time and PCA drug consumption in the experiment group were less than those in the control group （both P〈O. 05）. In the experiment group, there was no significant difference in postoperative VAS scores （6 and 12 hours） or PCA drug consumption between transverse incision （performed in 12 cases） and vertical incision （13 cases, P〉0. 05）. No adverse reactions caused by transversus abdominis plane puncture were found. Conclusion Ultrasound-guided subcostal TAPB is safe and effective postoperative analgesia for patients undergoing caesarean section. （Shanghai Med J, 2014, 37： 297-299）

关 键 词：超声引导 腹横肌平面神经阻滞 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]