超声引导下腹横肌平面阻滞对剖宫产产妇催乳素及术后镇痛的影响  

Effects of ultrasound-guided transversus abdominis plane block on prolactin level and postoperative analgesia after caesarean section

作　　者：黄天丰 王存金 方向志 张扬 高巨 

机构地区：[1]扬州大学临床医学院(江苏省苏北人民医院)麻醉科,225001

出　　处：《临床麻醉学杂志》2016年第1期24-27,共4页Journal of Clinical Anesthesiology

基　　金：国家自然科学基金(81171838);江苏省医学重点人才(RC2011041)

摘　　要：目的评价超声引导下腹横肌平面阻滞对剖宫产产妇催乳素（PRL）及术后镇痛的影响。方法选择择期行剖宫产产妇40例,单胎,足月（孕38~41周）,年龄20~39岁,体重50~80kg,ASAⅠ或Ⅱ级,采用随机数字表法分为两组,每组20例。C组不实施腹横肌平面阻滞,T组于手术结束即刻在超声引导下行双侧腹横肌平面阻滞。术后所有患者均采用1μg/ml舒芬太尼行PCIA,负荷量2ml,背景输注速率2ml/h,单次剂量2ml,锁定时间15min。若VAS评分〉3分,静脉注射曲马多50mg行镇痛补救。记录初乳时间及术前30min、术后24、48h产妇血清PRL浓度;记录术后静息状态下2、4、12、24和48hVAS评分,术后24h内舒芬太尼累积消耗量,镇痛补救率,镇痛泵按压次数;术后24h内不良反应发生情况。结果 T组初乳时间明显早于C组（P〈0.05）;T组术后24、48h血清PRL浓度明显高于C组（P〈0.05）;T组母乳喂养成功率明显高于C组（P〈0.05）;T组术后静息状态下2、4、12和24hVAS评分明显低于C组（P〈0.05）;T组术后24h内舒芬太尼累积消耗量明显少于C组、镇痛补救率明显低于C组、镇痛泵按压次数明显少于C组（P〈0.05）;T组术后24h内恶心呕吐发生率明显低于C组（P〈0.05）。结论超声引导下腹横肌平面阻滞用于剖宫产术后镇痛可促进产妇早泌乳,提高母乳喂养成功率,镇痛效果显著,且不良反应较少,值得在临床推广应用。Objective To evaluate the effect of ultrasound-guided transversus abdominis plane （TAP） block on the prolactin level and its postoperative analgesia after caesarean section. Methods Forty puerperae, aged 20-39 years, weighed 50-80 kg, ASA Ⅰ or Ⅱ grade, scheduled for cesarean section, were randomly divided into 2 groups （n =20 each） using a random number table： control group （group C） and transversus abdominis plane block group（group T）. The patient in group T received transversus abdominis plane block with 0. 375% ropivacaine 20 ml in both sides under the guidance of ultrasound immediately at the end of surgery. A patient-controlled intravenous analgesia （PCIA） with 1 ~g/ml sufentanil was used after surgery and tramadol 50 mg was injected intravenously as rescue analgesia when VAS score〉3. The time for colostrums and the serum level of prolactin at 30 minutes before surgery, 24, 48 h postoperatively were detected, respectively. The visual analogue scale（VAS） at rest at 2, 4, 12, 24, 48 h after the surgery, the use of rescue analgesia, the cumulative consumption of sufentanil within 24 h, the times of pressing PCIA, and the adverse reaction occurred after the surgery were all recorded.Results The time for colostrums was earlier in group T. Compared with group C, the serum level of prolactin in group T were higher at 24, 48 h postoperatively. The VAS scores at 2, 4, 12, 24 h after surgery, the cumulative consumption of sufentanil within 24 h, the use of rescue analgesia, and the times of pressing PCIA in group T were significantly lower than those in group C （P〈0. 05）. The incidence of nausea and vomiting in group T within 24 h were also significantly reduced （P〈0. 05）.Conclusion Ultrasound-guided transversus abdominis plane block used for analgesia after caesarean section can promote early lactation, and the maternal analgesia effect is remarkable with less adverse reactions.

关 键 词：超声引导 神经阻滞 腹横肌平面阻滞 剖宫产 催乳素 镇痛 

分 类 号：R614[医药卫生—麻醉学]