超声引导下腹横肌平面阻滞用于剖宫产腰麻硬膜外联合麻醉时术中及术后效果观察  

Observation on the effects of ultrasound-guided transversus abdominis plane block in the combined spinal-epidural anesthesia for cesarean section

作　　者：刘欣[1] 姜山[1] 孔繁丽[1] 吴映辉[1] 冯春[1] 

机构地区：[1]武汉市妇女儿童医疗保健中心麻醉科,430016

出　　处：《临床外科杂志》2016年第8期629-632,共4页Journal of Clinical Surgery

摘　　要：目的观察超声引导下腹横肌平面(transversus abdominis plane,TAP)阻滞用于剖宫产腰麻硬膜外联合麻醉时的效果。方法腰麻硬膜外联合麻醉下行剖宫产术患者150例,随机分为两组:A组行腰麻硬膜外联合麻醉+TAP阻滞麻醉,B组行腰麻硬膜外联合麻醉+超声引导TAP阻滞麻醉,各75例。两组患者均采用腰麻硬膜外联合麻醉,记录患者术中不同时间点的平均动脉压(mean artery pressure,MAP)、心率(heart rate,HR)、疼痛评分以及术中牵拉反射发生率,同时观察并记录患者手术结束后2小时、4小时、8小时、16小时、24小时、36小时的疼痛评分、术后不良反应发生率、患者术后镇痛泵按压次数以及患者首次下地活动时间。结果 B组患者术中不同时间点MAP、HR的变化以及疼痛评分优于A组(P<0.05);B组患者术中牵拉反射发生率明显低于A组(P<0.05);两组患者术后2小时的疼痛评分比较差异无统计学意义(P>0.05),但是B组患者术后4—36小时的疼痛评分明显优于A组(P<0.05),B组患者术后不良反应发生率以及镇痛泵按压次数也少于A组(P<0.05);B组患者首次下地活动时间明显提前于A组(P<0.05)。结论超声引导下TAP阻滞用于剖宫产腰硬联合麻醉时成功率高,麻醉效果更加确切,不良反应少且术后持续镇痛效果好。Objective To observe the effects of ultrasound-guided transversus abdominis plane （TAP） block in the combined spinal-epidural anesthesia for cesarean section. Methods A total of 150 females, who were scheduled to cesarean sections, were enrolled in the study. The patients were randomly divided into group A （combined spinal-epidural anesthesia plus TA） and group B （combined spinal-epi- dural anesthesia plus ultrasound-guided TAP）, with 75 cases in each group. Combined with spinal-epi- dural anesthesia was used in both two groups. During the operation, the mean arterial pressure （MAP）. heart rate （HR）, pain scores at different time points and incidences of tractive reaction were recorded. Af- ter the operation, all patients were assessed at 2,4,8,16,24 and 36 h after operation for pain scores. The incidence of postoperative adverse reactions, use of patient-controlled analgesia pump. and time to flint am- bulation in the two groups were also recorded. Results The changes of MAP. HR and the pain scores at different time points during the operations in group B were significantly superior to group A. The incidence of tractive reaction during the operation in group B was significantly lower than group A （P 〈 0.05）. Ex- cept the pain score at 2h after operation, pain scores at 4 ~ 36 h after operations in group B were superior to group A （ P 〈 0.05 ） ; the incidences of postoperative adverse reaction and use of patient-controlled an- algesia pump in group B were less than group A （ P 〈 0.05 ） ; the time to first ambulation in group B was earlier than group A （P 〈 0.05 ）. Conclusion Compared with the traditional TAP block, ultrasound- guided TAP block can not only enhance the analgesic effects during combined spinal-epidural anesthesia, but also reduce the adverse reaction and ease pain after the operation.

关 键 词：超声引导 腹横肌平面阻滞 剖宫产 腰麻硬膜外联合麻醉 镇痛 牵拉反射 

分 类 号：R614.4[医药卫生—麻醉学]