超声引导下不同入路腹横肌平面阻滞对剖宫产手术后镇痛的影响  

Analgesic efficacy in different approach of ultrasound- guided transversus abdominis plane block after cesarean delivery

作　　者：谢海[1] 李艳[2] 

机构地区：[1]海南医学院附属医院麻醉科,海口570102 [2]海南省人民医院麻醉科,海口570102

出　　处：《首都医科大学学报》2015年第5期791-793,共3页Journal of Capital Medical University

摘　　要：目的比较超声引导下腋前线入路和肋下入路腹横肌平面阻滞在纵切口剖宫产手术后镇痛的效果。方法实施单次蛛网膜下腔麻醉下纵切口剖宫产单胎足月孕初产妇144例,采用数字表法随机分为A组(腋前线入路组)和B组(肋下入路组)(n=72)。两组均在手术结束后在超声引导下行腹横肌平面阻滞,超声确定到达腹横肌平面后,双侧各注入0.25%罗哌卡因30m L。观察术后6、12、24、48 h时点视觉模拟评分(visual analogue score,VAS)情况、两组镇痛强度达峰时间、术后下床活动时间和患者对术后镇痛方式的满意度。结果术后6、12 h、24、48 h时点,两组的疼痛VAS差异均无统计学意义(P>0.05)。A组镇痛强度达峰时间为(2.9±1.8)h;B组镇痛强度达峰时间为(2.6±1.4)h。两组的镇痛强度达峰时间和平均下床活动时间差异均无统计学意义(P>0.05),两组产妇镇痛满意度差异均无统计学意义(P>0.05)。结论超声引导下腋前线入路或肋下入路腹横肌平面阻滞均可提供24 h内纵切口下剖宫产手术镇痛,两种方法的术后镇痛效果无区别。Objective To compare the analgesic efficacy of anterior axillary line approach with subcostal approach in ultrasound-guided transversus abdominis plane block after cesarean delivery. Methods Singlebirth primigravida 144 cases undergone longitudinal incision cesarean section with single spinal anesthesia were randomly divided into group A（ anterior axillary line approach group） and group B（ subcostal approach group）（ n = 72）. All cases in the two groups were done via ultrasound guided transversus abdominis plane block after surgery; 30 m L of 0. 25% ropivacaine were injected in each side after ultrasound to determine the transversus abdominis plane.Visual analogue pain（ VAS） score in postoperative 6,12,24,48 h time points,analgesic intensity peak time,postoperative ambulation time and patient satisfaction with postoperative analgesia in the two groups were observed. Results Visual analog pain（ VAS） score in postoperative 6,12,24,48 h time point between the two groups was not statistically significant difference（ P〈0. 05）. Time of analgesic intensity peak time in group A was（ 2. 9 ± 1. 8） h and group B（ 2. 6 ± 1. 4） h with no significant difference（ P〈0. 05）. The average time to get out of bed in the two groups showed no significant difference（ P〈0. 05）. Patient satisfaction with postoperative analgesia in the two groups was no significant difference（ P〈0. 05）. Conclusion Postoperative analgesia in cesarean section with longitudinal incision via either anterior axillary line approach or subcostal approach in ultrasound- guided transversus abdominis plane block is available within 24 hours,both approaches are without difference.

关 键 词：超声引导腹横肌平面阻滞 不同入路 剖宫产 镇痛 

分 类 号：R614[医药卫生—麻醉学]