超声引导下腹横肌平面阻滞在疤痕子宫产妇剖宫产术后镇痛中的效果  

Effect of ultrasound-guided transversus abdominis plane block on postoperative maternal analgesia after repeated cesarean section

作　　者：夏凡[1] 徐世琴[1] 李彩娟[1] XIA Fan;XU Shiqin;LI Caijuan(Department of Anesthesiology,Women s Hospital of Nanjing Medical University,Nanjing Maternity and Child Health Care Hospital,Nanjing 210004,China)

机构地区：[1]南京医科大学附属妇产医院(南京市妇幼保健院)麻醉科,210004

出　　处：《临床麻醉学杂志》2022年第1期34-37,共4页Journal of Clinical Anesthesiology

基　　金：南京医科大学科技发展基金(NMUB2018128)。

摘　　要：目的观察超声引导下腹横肌平面阻滞(TAPB)在疤痕子宫产妇剖宫产术后镇痛中的效果。方法选择择期剖宫产的疤痕子宫经产妇84例,年龄20~45岁,体重60~80 kg,BMI≤30 kg/m^(2),ASAⅡ级,孕期37~42周。将产妇随机分为两组:布托啡诺PCIA组(P组)和布托啡诺PCIA联合TAPB组(PT组),每组42例。术中两组均采用腰-硬联合麻醉。术后两组均予布托啡诺PCIA,PT组在此基础上行超声引导下TAPB。术后VAS疼痛评分≥4分时,静脉追加布托啡诺1 mg补救镇痛。记录术后0~6 h、6~12 h、12~18 h、18~24 h镇痛泵布托啡诺用量。记录首次按压镇痛泵时间、镇痛泵有效按压次数及补救镇痛例数。于术前及术后6 h采集静脉血,检测血清P物质浓度。记录术后24 h镇痛满意例数及恶心、呕吐、头晕等阿片类药物相关不良反应的发生情况。结果与P组比较,PT组术后0~6 h镇痛泵布托啡诺用量及镇痛泵有效按压次数明显减少(P<0.05),首次按压镇痛泵时间明显延迟(P<0.05),补救镇痛率明显降低(P<0.05)。与术前比较,术后6 h两组血清P物质浓度明显升高(P<0.05)。术后24 h两组镇痛满意率及不良反应发生率差异无统计学意义。结论布托啡诺PCIA联合TAPB能够有效减少剖宫产术后6 h内布托啡诺用量,改善镇痛效果,适用于疤痕子宫剖宫产术后多模式镇痛。Objective To observe the effect of ultrasound-guided transversus abdominis plane block(TAPB)on postoperative maternal analgesia after repeated cesarean section.Methods Eighty-four multipara with scarred uterus undergoing second cesarean section,aged 20-45 years,weighing 60-80 kg,BMI≤30 kg/m^(2),and 37-42 gestational weeks,ASA physical statusⅡ,were randomly divided into two groups:butorphanol patient-controlled intravenous analgesia(PCIA)group(group P)and butorphanol PCIA combined with TAPB group(group PT),42 multiparas in each group.Both groups received combined lumbar and epidural anesthesia.Both groups were given butorphanol PCIA after surgery,on top of which group PT was given TAPB guided by ultrasound.When postoperative VAS pain score≥4 scores,butorphanol 1 mg was added intravenously.The dosage of butorphanol in analgesic pump was recorded at 0-6 hours,6-12 hours,12-18 hours,and 18-24 hours postoperatively.The first pressing time of analgesic pump,the effective pressing times of analgesic pump and the number of remedial analgesia were recorded.Venous blood was collected before and 6 hours after operation to detect serum substance P concentration.Satisfactory cases of analgesia and the incidence of opioid-related adverse reactions such as nausea,vomiting and dizziness were recorded 24 hours after operation.Results Compared with group P,the pressing times of analgesic pump and the dosage of butorphanol in analgesic pump were significantly reduced in group PT at 0-6 hours after operation(P<0.05),the incidence of remedial analgesia was also significantly reduced and the time of first pressing of analgesic pump was significantly delayed in group PT(P<0.05).Compared with that before operation,the serum concentration of substance P in the two groups was significantly increased 6 hours after operation(P<0.05).There was no significant difference in the rate of analgesia satisfaction and the incidence of adverse reactions between the two groups 24 hours after operation.Conclusion Ultrasound-guided TAPB combined w

关 键 词：布托啡诺 患者自控静脉镇痛 腹横肌平面阻滞 疤痕子宫 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]