多模式镇痛方案下超声引导腰方肌阻滞与腹横肌平面阻滞在剖宫产术后快速康复中的效果比较  

Ultrasound-guided quadratus lumborum block versus transversus abdominis plane block under multimodal analgesia for enhanced recovery after caesarean section

作　　者：孔德华 孔宪刚[2] 王昆[2] 尤培军[2] Kong Dehua;Kong Xiangang;Wang Kun;You Peijun(Department of Obstetrics,Jining No.1 People's Hospital,Jining 272011,China;Department of Anesthesiology,Jining No.1 People's Hospital,Jining 272011,China)

机构地区：[1]济宁市第一人民医院产科,272011 [2]济宁市第一人民医院麻醉科,272011

出　　处：《国际麻醉学与复苏杂志》2020年第7期672-677,共6页International Journal of Anesthesiology and Resuscitation

摘　　要：目的比较多模式镇痛方案下超声引导腰方肌阻滞(quadratus lumborum block,QLB)与腹横肌平面阻滞(transversus abdominis plane block,TAPB)在剖宫产术后快速康复中的效果。方法择期拟行剖宫产术产妇60例,单胎,足月妊娠(孕周>37周),ASA分级Ⅰ、Ⅱ级,采用随机数字表法分为两组(每组30例):QLB组和TAPB组。两组均行蛛网膜下腔麻醉。术毕超声引导下QLB组行双侧QLB,TAPB组行双侧TAPB,两组每侧分别注射0.375%罗哌卡因20 ml。术后均行患者自控静脉镇痛(patient controlled intravenous analgesia,PCIA)。记录两组术后4、8、12、24、48 h静息和运动状态疼痛数字评分量表(Numeric Rating Scale,NRS)评分。记录术后首次按压镇痛泵时间,术后24 h内镇痛泵有效按压次数、舒芬太尼累积用量、镇痛补救率、镇痛满意度及不良反应发生情况。记录术后排气、普通饮食、坐起、站立、下床行走的首次时间和初乳时间。结果QLB组术后24、48 h静息及术后8、12、24、48 h运动状态NRS评分明显低于TAPB组(P<0.05)。QLB组术后首次按压镇痛泵时间明显长于TAPB组,术后24 h内镇痛泵有效按压次数及舒芬太尼累积用量明显少于TAPB组,镇痛满意度明显高于TAPB组(P均<0.05)。QLB组术后首次下床行走时间及初乳时间明显短于TAPB组(P<0.05)。两组在镇痛补救率、术后24 h内镇痛相关不良反应发生率及术后首次排气时间、首次普通饮食时间、首次坐起时间、首次站立时间方面比较差异无统计学意义(P>0.05)。结论QLB作为剖宫产术后多模式镇痛方案的一部分比TAPB具有更好的术后镇痛效果,可减少术后阿片类药物的用量,但是否比TAPB更有助于产妇术后快速康复尚需进一步的研究验证。Objective To compare the effects of ultrasound-guided quadratus lumborum block(QLB)and transversus abdominis plane block(TAPB)in multimodal analgesia on the enhanced recovery after caesarean section.Methods Sixty parturients,single birth and full-term pregnancy(gestational age>37 weeks),American Society of Anesthesiologists(ASA)gradeⅠorⅡ,scheduled for cesarean section were divided into 2 groups according to random number table method(n=30):a QLB group and a TAPB group.Spinal anesthesia was used in both groups.At the end of the surgery,patients in the QLB group received bilateral QLB,while patients in the TAPB group received bilateral TAPB under ultrasound guidance immediately.Both groups were injected with 20 ml of 0.375%ropivacaine in each side respectively.All patients underwent patient controlled intravenous analgesia(PCIA).The resting and exercise Numeric Rating Scale(NRS)scores were recorded at 4,8,12,24 h and 48 h after operation.The time of the first pressing analgesia pump,the effective pressing times of analgesia pump within 24 h after operation,the cumulative consumption of sufentanil,the rate of rescue analgesia,the degree of satisfaction with analgesic effect and the adverse reaction within 24 h after operation were recorded.The first time of anal exhaust,eating common food,sitting up,standing up,getting out of bed after operation and colostrum production were also recorded.Results The resting NRS scores at 24,48 h and the exercise NRS scores at 8,12,24,48 h after operation were significantly lower in QLB group than those values in TAPB group(P<0.05).The time of the first pressing analgesia pump in QLB group was significantly later than that time in TAPB group.The degree of satisfaction with analgesic effect in QLB group was significantly higher than that in TAPB group.The effective pressing times of analgesia pump and the cumulative consumption of sufentanil within 24 h after operation were significantly lower than those values in TAPB group(P<0.05).Meanwhile,the first time of getting out of bed

关 键 词：腰方肌阻滞 腹横肌平面阻滞 快速康复外科 多模式镇痛 剖宫产术 

分 类 号：R614[医药卫生—麻醉学] R719.8[医药卫生—外科学]