右美托咪定复合罗哌卡因腹横肌平面阻滞对剖宫产产妇术后催乳素及术后镇痛的影响  

Effect of transversus abdominis plane block with combination of dexmedetomidine and ropivacaine on prolactin levels and postoperative analgesia after caesarean section

作　　者：郭高锋[1] 阮孝国[1] 张加强[1] Guo Gaofeng;Ruan Xiaoguo;Zhang Jiaqiang(Department of Anesthesiology, Henan Provincial People＇s Hospital, Zhengzhou 450003, Chin)

机构地区：[1]河南省人民医院麻醉科,郑州450003

出　　处：《国际麻醉学与复苏杂志》2018年第4期328-332,共5页International Journal of Anesthesiology and Resuscitation

摘　　要：目的探讨右美托咪定（dexmedetomidine，Dex）复合罗哌卡因腹横肌平面阻滞（transversus abdominis plane block，TAPB）对剖宫产产妇术后催乳素（prolactin，PRL）和术后镇痛及安全性的影响。方法择期椎管内麻醉行剖宫产术的产妇50例，年龄20～40岁，ASA分级Ⅰ、Ⅱ级，采用随机数字表法分为A组和B组，每组25例。两组产妇均于手术结束时在超声引导下行双侧TAPB，A组应用0．33％罗哌卡因30ml，B组应用0．75g／kg Dex复合0．33％罗哌卡因30ml。记录初乳时间，术前及术后12、24、48h产妇血清PRL浓度；记录产妇术后6、12、24、48h静息VAS评分、运动VAS评分及术后恶心呕吐（postoperative nausea and vomiting，PONV）、呼吸抑制、头晕头痛等副作用发生情况。结果B组产妇初乳时间明显早于A组（P〈0．05）。术前两组血清PRL浓度差异无统计学意义（P〉0．05），术后12、24、48hB组血清PRL浓度高于A组（P〈0．05）。两组术后6、12h静息VAS评分差异无统计学意义（P〉0．05），但术后24、48hA组静息VAS评分高于B组（P〈0．05）。术后6、12、24、48hA组运动VAS评分高于B组（P〈0．05）。术后6、12、24、48hB组PONV、头晕头痛等副作用发生率低于A组（P〈0．05）。结论0．75g／kg Dex复合0．33％罗哌卡因30ml TAPB用于剖宫产产妇，有利于早泌乳，能提供安全有效的术后镇痛，且副作用较少。Objective To observe the effect of transversus abdominis plane block （TAPB） with combination of dexmedetomidine（Dex） and ropivacaine on prolactin（PRL） levels and postoperative analgesia after caesarean section. Methods Fifty patients （20-40 years old, ASA Ⅰ or Ⅱ） subjected to cesarean section under spinal cord anesthesia were randomly divided into two groups（A and B, 25 patients in each group）. All patients received bilateral TAPB with rnpivacaine（0.33%, 30 ml） under the guidance of ultrasound immediately after caesarean section. Patients in group B, but not group A, received additional 0.75 g/kg Dex. The time for colostrum production, and occurrence of postoperative nausea and vomiting （PONV）, respiration depression, and dizziness were recorded. The levels of prolactin before and after surgery were measured. VAS at rest and during activity were assessed 6, 12, 24, 48 h after the operation. Results The time for colostrum production was earlier in group B than group A （P〈0.05）. The serum levels of prolactin 12, 24, 48 h after the surgery were higher in group B than group A. The VAS scores at rest 6 and 12 h after operation were not significantly different between two groups（P〉0.05）. However, the VAS scores were higher in group A（P〈0.05）. VAS scorcs during activity 6, 12, 24, 48 h after the operation were lower in group B than in group A （P〈0.05）. The incidences of PONV and dizziness 6, 12, 24, 48 h after the operation were significantly decreased in group B, compared with group A（P〈0.05）. Conclusions TAPB with the combination of 0.75 g/kg Dex and 0.33% ropivacaine after caesarean section can promote early lactation, maintain maternal analgesia effect, and minimize adverse reactions.

关 键 词：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]