超声引导髂腹下／髂腹股沟神经阻滞和腹横肌平面阻滞用于剖宫产术后镇痛的效果  

Efficacy of ultrasound-guided iliohypogastric/ilioinguinal nerve block and transversus abdominis plane block for analgesia after cesarean section

作　　者：刘楠[1] 张熙哲[1] 冯艺[1] 

机构地区：[1]北京大学人民医院麻醉科,100044

出　　处：《中华麻醉学杂志》2016年第9期1098-1101,共4页Chinese Journal of Anesthesiology

摘　　要：目的探讨超声引导髂腹下/髂腹股沟神经阻滞和腹横肌平面阻滞用于剖宫产术后镇痛的效果。 方法选择脊椎-硬膜外联合麻醉下剖宫产术产妇90例，年龄20～40岁，ASA分级Ⅰ或Ⅱ级，采用随机数表法分为3组：对照组（C组）、超声引导髂腹下/髂腹股沟神经阻滞组（IH/II组）和超声引导腹横肌平面阻滞组（TAP组），每组30例。IH/II组术后行双侧髂腹下/髂腹股沟神经阻滞，TAP组术后行双侧腹横肌平面阻滞，每侧神经阻滞用药为0.5%罗哌卡因1.5 mg/kg＋地塞米松5 mg。3组术后均采用吗啡静脉自控镇痛，维持术后48 h内静态和动态疼痛数字评分〈4分。记录术后6、12、24、36和48 h的吗啡累积用量。记录镇痛期间恶心、呕吐、皮肤瘙痒、过度镇静和呼吸抑制等不良反应的发生情况。 结果与C组比较，IH/II组和TAP组各时点吗啡累积用量降低（P〈0.01）；与IH/II组比较，TAP组术后6和12 h时吗啡累积用量差异无统计学意义（P〉0.05），术后24、36和48 h时吗啡累积用量增加（P〈0.05）。均未见恶心、呕吐、皮肤瘙痒、过度镇静和呼吸抑制发生。 结论对于剖宫产术患者，超声引导髂腹下/髂腹股沟神经阻滞和腹横肌平面阻滞均可产生术后镇痛效果，且前者的效果较好。Objective To investigate the efficacy of ultrasound-guided iliohypogastric/ilioinguinal nerve block and transversus abdominis plane block for analgesia after cesarean section. Methods Ninety parturients, aged 20-40 yr, of American Society of Anesthesiologists physical status I or U , scheduled for elective cesarean section, were divided into 3 groups （n = 30 each） using a random number table： con- trol group （group C）, ultrasound-guided iliohypogastric/ilioinguinal nerve hlock group （group IH/II） and ultrasound-guided transversus abdominis plane block group （group TAP）. In IH/II and TAP groups, bilat- eral ultrasound-guided iliohypogastric/ilioinguinal nerve block and transversus abdominis plane block were performed after surgery, respectively, with 0.5% ropivacaine 1.5 mg/kg （the maximal dose 100 rag） plus dexamethasone 5 mg for each side. All the patients received patient-controlled intravenous analgesia with morphine after surgery, and numeric rating scales scores at rest and during movement were maintained〈4 within the 48 h after surgery. The cumulative consumption of morphine was recorded at 6, 12, 24, 36 and 48 h after surgery. The occurrence of adverse reactions such as nausea, vomiting, pruritus, over-sedation and respiratory depression was observed and recorded in the analgesic period. Results Compared with group C, the cumulative consumption of morphine was significantly decreased at each time point in IH/II and TAP groups （P〈0.01）. Compared with group IH/II, no significant change was found in the cumulative consumption of morphine at 6 and 12 h after surgery, and the cumulative consumption of morphine was sig- nificantly increased at 24, 36 and 48 h after surgery in group TAP （P〈0.05）. No nausea, vomiting, pruritus, over-sedation and respiratory depression was found in IH/II and TAP groups. Conclusion For par- turients, ultrasound-guided iliohypogastric/ilioinguinal nerve block and transversus abdominis plane block both can provide analgesic efficacy after cesarean s

关 键 词：髂骨 腹肌 神经传导阻滞 超声检查 镇痛 产科 

分 类 号：R614[医药卫生—麻醉学]