超声引导下腹横肌平面阻滞联合右美托咪定用于剖宫产的效果观察  

Effect of ultrasound-guided transverse abdominal plane block combined with dexmedetomidine on cesarean section

作　　者：王清兵[1] 路超[2] 于刚[1] Wang Qingbing;Lu Chao;Yu Gang(Department of Anesthesiology,Binzhou Central Hospital,Binzhou 251700,Shandong Province,China;Department of Obstetrics,Binzhou Central Hospital,Binzhou 251700,Shandong Province,China)

机构地区：[1]滨州市中心医院麻醉科,山东省251700 [2]滨州市中心医院产科,山东省251700

出　　处：《中国基层医药》2021年第4期579-583,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的:探讨超声引导下腹横肌平面阻滞(TAP)联合右美托咪定用于剖宫产的效果。方法:选取滨州市中心医院2017年10月至2019年10月择期全身麻醉剖宫产产妇80例为研究对象,采用随机数字表法分为观察组和对照组各40例,对照组按常规方法全身麻醉后行剖宫产术,术后给予静脉自控镇痛;观察组麻醉诱导前在超声引导下行TAP阻滞,同时静脉泵入右美托咪定。比较两组产妇镇痛效果及对产妇和新生儿的影响。结果:术后2 h、4 h、12 h,观察组视觉模拟评分法(VAS)评分分别为(2.1±0.9)分、(2.2±0.7)分、(3.0±0.6)分,均明显低于对照组的(4.4±1.3)分、(4.9±1.2)分、(3.9±0.8)分(t=8.946、7.854、6.246,均P<0.05),观察组舒适度评分分别为(3.4±0.8)分、(3.2±0.7)分、(3.3±0.7)分,均明显高于对照组的(2.1±0.7)分、(2.2±0.9)分、(2.5±0.8)分(t=7.235、6.130、5.953,均P<0.05)。术后,观察组镇痛泵按压次数为(8.4±2.9)次,少于对照组的(13.1±3.7)次,镇痛满意度为97.50%(39/40),高于对照组的77.50%(31/40)(t=7.036,χ^(2)=9.347,均P<0.05)。术后1 d、2 d,观察组静脉自控镇痛累计用量分别为(52.1±1.9)mL、(121.7±4.1)mL,均少于对照组的(63.6±2.4)mL、(146.5±5.3)mL(t=6.240、8.842,均P<0.05),拔管质量评分为(1.3±0.3)分,低于对照组的(3.2±0.5)分(t=6.664,P<0.05)。两组拔管后10 min、胎儿取出、切皮、插管各时间点皮质醇含量差异均有统计学意义(均P<0.05)。观察组脐带血二氧化碳分压明显减少,氧分压、氧合指数明显升高,出生1 min时Apgar评分明显升高(均P<0.05)。结论:超声引导下TAP阻滞联合右美托咪定可提高剖宫产产妇镇痛效果,延长镇痛时间,减少镇痛药的使用量,提高手术效果,降低母体应激反应,更好的促进母婴健康。Objective To investigate the effect of ultrasound-guided transverse abdominal plane block combined with dexmedetomidine on cesarean section.Methods Eighty pregnant women undergoing elective cesarean section under general anesthesia in Binzhou Central Hospital from October 2017 to October 2019 were included in this study.They were randomly assigned to undergo either cesarean section under general anesthesia followed by patient-controlled intravenous analgesia(control group,n=40)or ultrasound-guided transverse abdominal plane block combined with intravenous dexmedetomidine administration(observation group,n=40).Analgesic efficacy and the analgesic effect on puerperas and their newborns were compared between the observation and control groups.Results At 2,4 and 12 hours after surgery,the Visual Analogue Scale score in the observation group was(2.1±0.9)points,(2.2±0.7)points,(3.0±0.6)points,respectively,which was significantly lower than(4.4±1.3)points,(4.9±1.2)points,(3.9±0.8)points in the control group,respectively(t=8.946,7.854,6.246,all P<0.05).At 2,4 and 12 hours after surgery,the comfort score in the observation group was(3.4±0.8)points,(3.2±0.7)points,(3.3±0.7)points,respectively,which was significantly higher than(2.1±0.7)points,(2.2±0.9)points and(2.5±0.8)points respectively in the control group(t=7.235,6.130,5.953,all P<0.05).After surgery,the number of times the demand button of the anesthesia pump in the observation group was pressed was(8.4±2.9),with the rate of patient satisfaction of 97.50%(39/40),which was significantly higher than that in the control group[13.1±3.7,77.50%(31/40),t=7.036,χ^(2)=9.347,both P<0.05).At 1 and 2 days after surgery,the cumulative amount of anesthetics used for patient-controlled intravenous analgesia was(52.1±1.9)mL and(121.7±4.1)mL respectively,which were less than(63.6±2.4)mL and(146.5±5.3)mL in the control group,respectively(t=6.240 and 8.842,both P<0.05).The score of extubation quality in the observation group was significantly lower than that in the c

关 键 词：剖宫产术 麻醉和镇痛 超声检查 腹横肌平面阻滞 右美托咪定 镇痛 病人控制 疼痛测定 皮质醇 妊娠结局 病人满意度 

分 类 号：R614[医药卫生—麻醉学]