TAP阻滞联合硬膜外镇痛泵对剖宫产术后镇痛效果及胃肠功能的影响  

Effects of tap block combined with epidural analgesia pump on postoperative analgesia and gastrointestinal function of patients after cesarean section

作　　者：寇卜伟 李国庆 KOU Buwei;LI Guoqing(Department of Anesthesiology,Shenyang Hospital for Maternal and Child Health,Liaoning,Shenyang 110013,China)

机构地区：[1]辽宁省沈阳市妇幼保健院麻醉科,110013

出　　处：《河北医药》2022年第2期228-231,共4页Hebei Medical Journal

摘　　要：目的分析双侧腹横肌平面(TAP)阻滞联合硬膜外镇痛泵对剖宫产术后镇痛效果及胃肠功能的影响。方法选取2019年2月至2020年2月收治的98例剖宫产患者,按照随机数字表法将其分为观察组和对照组,每组49例。对照组患者常规硬膜外麻醉下行剖宫产手术,并与术后给予硬膜外镇痛泵进行术后镇痛。观察组患者在对照组基础上进行TAP阻滞,观察并记录2组患者性别、年龄、体重、手术时间、术中出血、补液量、疼痛评分、术后视觉模拟疼痛评分(VAS)、镇痛情况、胃肠激素水平、恢复时间。结果2组患者术后VAS差异有统计学意义(P<0.05),观察组患者术后术后6、24、48 h VAS评分显著低于对照组(P<0.05);2组患者镇痛泵夹闭次数比较差异无统计学意义(P>0.05),观察组患者PCEA次数、舒芬太尼使用量、医师干预次数显著低于对照组患者(P<0.05),观察组48 h镇痛泵剩余量显著高于对照组(P<0.05);观察组患者胃动素水平明显高于对照组(P<0.05),而胃泌素水平则明显低于对照组(P<0.05);观察组患者排气排便恢复时间、肠鸣音恢复时间、住院时间、泌乳时间均明显低于对照组(P<0.05)。结论TAP阻滞联合硬膜外镇痛较单纯硬膜外麻醉及镇痛更能有效提高剖宫产患者术后镇痛效果,并加快患者术后恢复。Objective To investigate the effects of tap block combined with epidural analgesia pump on postoperative analgesia and gastrointestinal function of patients after cesarean section.Methods A total of 98 patients who underwent cesarean section in our hospital from February 2019 to February 2020 were randomly divided into observation group and control group,with 49 cases in each group.The patients in control group received routine epidural anesthesia for cesarean section and epidural analgesia pump for postoperative analgesia,however,thepatients in observation group,on the basis of control group,were treated by bilateral transverse plane block(TAP).The patient’s sex and age,body weight,operation time,intraoperative hemorrhage volume,fluid infusion,pain score,postoperative VAS score,analgesia effects,gastrointestinal hormone level and recovery time were observed and compared between the two groups.Results The VAS scores at 6h,24h and 48h after operation in observation group were significantly lower than those in control group(P<0.05).There were no significant differences in the clamping times of the analgesia pump between the two groups(P>0.05),and the PCEA application frequency,sufentanil dosage and physician intervention times in observation group were significantly lower than those in control group(P<0.05).The motilin levels in observation group were significantly higher than those in control group(P<0.05),however,the gastrin levels were significantly lower than those in control group(P<0.05).In addition the recovery time of exhaust and defecation,bowel sounds,hospitalization time and lactation time in observation group were significantly lower than those in control group(P<0.05).Conclusion Compared with simple epidural anesthesia and analgesia,TAP block combined with epidural analgesia can effectively improve the postoperative analgesia effects,gastrointestinal function and recovery time of patients undergoing cesarean section.

关 键 词：腹横肌平面阻滞 胃肠功能 硬膜外镇痛 剖宫产 

分 类 号：R614[医药卫生—麻醉学]