低浓度左旋布比卡因腹横肌平面阻滞在剖宫产术后镇痛中的应用观察  

Application observation of low concentration Levobupivacaine to transversus abdominis plane block in postoperative analgesia after cesarean section

作　　者：林若萍 何依红 张伟娟 杨庆耿 胡美梅 LIN Ruo-ping;HE Yi-hong;ZHANG Wei-juan;YANG Qing-geng;HU Mei-mei(Department of Anesthesiology, Huizhou Maternal and Child Health Family Planning Service Center, Guangdong Province, Huizhou 516001, China;Department of Anesthesiology. Huizhou Sixth People's HospitaL Guangdong Province,Huizhou 516001, China)

机构地区：[1]广东省惠州市妇幼保健计划生育服务中心麻醉科,广东惠州516001 [2]广东省惠州市第六人民医院麻醉科,广东惠州516001

出　　处：《中国当代医药》2019年第15期109-112,共4页China Modern Medicine

基　　金：广东省惠州市医疗卫生类科技计划项目(2018Y056)

摘　　要：目的探讨低浓度左旋布比卡因腹横肌平面(TAP)阻滞在剖宫产术后镇痛中的效果,并分析其可行性及安全性.方法选取2017年9月~2018年7月广东省惠州市妇幼保健计划生育服务中心收治的64例行剖宫产手术的产妇作为研究对象,随机分为研究组与对照组,每组各32例.研究组给予产妇超声引导下TAP阻滞,注入15ml0.25%的左旋布比卡因,对照组给予产妇传统硬膜外阻滞,注入7.5ml0.5%左旋布比卡因,两组均在20s内注射完毕.比较两组产妇的感觉阻滞起效时间、镇痛效果、运动阻滞恢复时间、心率(HR)以及血压[收缩压(SBP)、舒张压(DBP)]水平.结果研究组产妇的感觉阻滞起效时间与运动阻滞恢复时间明显短于对照组,差异有统计学意义(P<0.05);研究组产妇的镇痛总有效率明显高于对照组,改良Bromage评分明显低于对照组,差异均有统计学意义(P<0.05),研究组产妇给药后5min的HR明显低于对照组,SBP和DBP水平明显高于对照组,差异均有统计学意义(P<0.05).结论低浓度左旋布比卡因TAP阻滞镇痛效果显著且安全,血流动力学稳定性高,值得临床借鉴.Objective To investigate the effect of low concentration Levobupivacaine to transversus abdominis plane (TAP) block in postoperative analgesia after cesarean section, and to analyze its feasibility and safety. Methods Sixty-four parturients who underwent cesarean section in Huizhou Maternal and Child Health Family Planning Service Center of Guangdong Province from September 2017 to July 2018 were randomly divided into study group and control group, with 32 cases in each group. The study group was given TAP block guided by ultrasound and injected with 15 ml 0.25% Levobupivacaine, the control group was given traditional epidural block and injected with 7.5 ml 0.5% Levobupivacaine, both groups were injected within 20 seconds. The onset time of sensory block, analgesic effect, recovery time of motor block, heart rate (HR) and blood pressure systolicblood peassure (SBP,DBP), were compared between the two groups. Results The onset time of sensory block and recovery time of motor block in the study group were significantly shorter than those in the control group, the differences were significant (PcO.05). The total effective rate of analgesia in the study group was significantly higher than that in the control group, and the improved Bromage score was significantly lower than that in the control group, the differences were significant (P<0.05). The HR of puerpera in the study group was significantly lower than that in the control group. 5 minutes after administration, and the levels of SBP and DBP were significantly higher than those in the control group, the differences were significant (P<0.05). Conclusion The analgesic effect of low concentration Levobupivacaine TAP block is significant and safe, and the hemodynamic stability is high, which is worthy of clinical reference.

关 键 词：左旋布比卡因 腹横肌平面阻滞 剖宫产术 镇痛 血流动力学 

分 类 号：R719.8[医药卫生—妇产科学]