双侧腹横肌平面阻滞联合硬膜外小剂量吗啡对剖宫产术后静脉镇痛的影响  

The analgesic effect of the bilateral transverse abdominal plane block combined with small doses of morphine in the epidural space on pain relief after cesarean section

作　　者：罗纯 卢强 张军 董春山 LUO Chun;LU Qiang;ZHANG Jun;DONG Chunshan(Department of Anesthesiology,The First People＇s Hospital of Hefei,Anhui,Hefei 230061,China)

机构地区：[1]安徽省合肥市第一人民医院麻醉科,安徽合肥230061

出　　处：《包头医学院学报》2018年第10期40-41,49,共3页Journal of Baotou Medical College

摘　　要：目的:探讨右美托咪定复合罗哌卡因双侧TAPB联合硬膜外隙小剂量吗啡对剖宫产术后患者静脉自控镇痛(Patient-controlled intravenous analgesia,PCIA)的影响。方法:择期连续硬膜外隙麻醉下剖宫产单胎足月初产妇60例,随机将患者分为对照组和观察组两组,对照组患者应用舒芬太尼PCIA联合硬膜外隙小剂量吗啡,观察组患者采用双侧TAPB联合硬膜外隙小剂量吗啡复合舒芬太尼,产妇缝皮时硬膜外隙注射吗啡1 mg,术后采用PCIA,术毕观察组产妇采用超声引导下水分离法行双侧TAPB,药物为右美托咪定1μg/kg复合0. 25%罗哌卡因,两侧各20 m L,观察术后4 h、8 h、24 h和48 h两组产妇休息和咳嗽时疼痛视觉模拟评分(VAS评分)、PCIA的按压次数和产妇术后对镇痛效果的总体满意度评分(Global satisfaction score,GSS)。结果:两组产妇休息时疼痛VAS评分无差异义(P> 0. 05);观察组产妇术后各时间点咳嗽时疼痛VAS高于对照组(P <0. 05);两组产妇术后PCIA按压次数差异有统计学意义(P <0. 05),观察组产妇对术后镇痛效果的GSS优于对照组(P <0. 05)。结论:剖宫产术后采用右美托咪定复合罗哌卡因行超声引导下双侧TAPB联合硬膜外隙小剂量吗啡,镇痛效果好,可降低产妇术后运动疼痛评分,值得临床推广。Objective： To investigate the effect of dexmedetomidine plus ropivacaine bilateral transverse abdominal plane block （TAPB） combined with small doses of morphine in the epidural space on patient-controlled intravenous analgesia （PCIA） after cesarean section. Methods： A selection of 60 cases of full-term single birth parturients in cesarean delivery under successive epidural space anesthesia were randomized into two groups. Patients in the control group were treated with sufentanil PCIA combined with morphine in small doses in the epidural space. Patients in the observation group were treated with bilateral TAPB combined with small dose of morphine in epidural space in recombination with sufentanil. Morphine 1 mg was injected into the epidural space of puerpera during suture. After the operation, PCIA was used, and patients in the observation group were treated with ultrasound-guided water separation for bilateral TAPB. The drug was dexmedetomidine 1 μg/kg plus 0.25% ropivacaine, 20 mL on each side. The visual analogue score （VAS score）, the number of PCIA presses and the global satisfaction score （GSS） on the analgesic effect of the pregnant women at rest and cough at 4 h, 8 h, 24 h and 48 h after operation were observed. Results： There was no difference in VAS score in pain between the two groups when the parturients were at rest （ P 〉0.05）. The pain score of VAS was higher in the observation group than that in the control group during cough at different time points after operations （ P 〈0.05）. There was statistically significant difference in the number of PCIA presses in the parturients after operation between the two groups （ P 〈0.05）. GSS of postoperative analgesic effect in the observation group was better than that in the control group （ P 〈0.05）. Conclusion： After cesarean section, dexmedetomidine combined with ropivacaine for ultrasound-guided bilateral TAPB combined with small dose of morphine in epidural space is of good analgesic effect, which can reduce

关 键 词：腹横肌平面阻滞 右美托咪啶 吗啡 剖宫产术 术后疼痛 

分 类 号：R614[医药卫生—麻醉学]