右美托咪定和芬太尼分别联合罗哌卡因对腹横肌平面阻滞剖宫产产妇的影响  

Effect of dexmedetomidine combined with ropivacaine and fentanyl combined with ropivacaine for transversus abdominis plane block in women with cesarean section

作　　者：孙颖 刘庄[2] 刘晓利 赵倩倩 阮芳[1] SUN Ying;LIU Zhuang;LIU Xiaoli;ZHAO Qianqian;RUAN Fang(Department of Anesthesiology,Affiliated Hospital of Jining Medical College,Jining,Shandong,272007;Department of Reproductive Medicine,Affiliated Hospital of Jining Medical College,Jining,Shandong,272007)

机构地区：[1]济宁医学院附属医院麻醉科,山东济宁272007 [2]济宁医学院附属医院生殖医学科,山东济宁272007

出　　处：《实用临床医药杂志》2022年第14期109-113,共5页Journal of Clinical Medicine in Practice

摘　　要：目的探讨右美托咪定、芬太尼分别联合罗哌卡因对腹横肌平面阻滞(TAPB)剖宫产产妇术后疼痛及血流动力学指标的影响。方法选取接受剖宫产手术的120例产妇为研究对象,按照入院奇偶顺序将所有产妇分为A组和B组,每组60例。A组给予芬太尼联合罗哌卡因麻醉,B组给予右美托咪定联合罗哌卡因麻醉,2组产妇在超声引导下行双侧TAPB。采用视觉模拟评分法(VAS)以及术后24 h恢复质量量表(QoR-40)评估2组产妇术后疼痛和恢复情况,统计2组产妇心率(HR)、血氧饱和度(SpO_(2))、泌乳素分泌水平、平均动脉压(MAP)、有效按压次数、新生儿情况及不良反应发生情况。结果2组产妇术后6、12、24 h的VAS评分高于术后2 h,术后12 h VAS评分高于术后6 h,术后24 h VAS评分均低于术后6、12 h,差异有统计学意义(P<0.05);B组产妇术后6、12、24 h的VAS评分均低于A组,差异有统计学意义(P<0.05)。与术前比较,2组产妇术后8 h的MAP、SpO_(2)均下降,HR升高,但B组术后8 h的HR低于A组,SpO_(2)水平高于A组,差异有统计学意义(P<0.05);2组产妇术后12、24、48 h的泌乳素分泌水平高于术后即刻,术后48 h泌乳素水平高于术后12、24 h,且术后24 h泌乳素水平高于术后12 h,差异均有统计学意义(P<0.05);B组术后12、24、48 h的泌乳素水平均高于A组,差异有统计学意义(P<0.05)。B组QoR-40评分高于A组,有效按压次数少于A组,差异有统计学意义(P<0.05)。B组不良反应发生率为5.00%(3/60),低于A组的16.67%(10/60),差异有统计学意义(P<0.05)。结论右美托咪定和芬太尼均具有良好的镇痛效果,右美托咪定联合罗哌卡因改善术后疼痛效果优于芬太尼联合罗哌卡因,且其对心血管系统和血流动力学指标影响更小,有利于产妇早期泌乳,减少机体对麻醉药物的需求量,降低药物不良反应发生率,加速产妇产后早期恢复。Objective To investigate the effects of dexmedetomidine combined with ropivacaine and fentanyl combined with ropivacaine for transversus abdominis plane block(TAPB)on postoperative pain and hemodynamics in women with cesarean section.Methods A total of 120 puerperas who received cesarean section operations were selected as research objects.All women were divided into group A and group B according to the admission parity order,with 60 cases in each group.Group A was given fentanyl combined with ropivacaine for anesthesia,while group B was given dexmedetomidine combined with ropivacaine for anesthesia.The puerperas of two groups given bilateral TAPB under the guidance of ultrasound.Visual Analogue Scale(VAS)and Quality of Recovery Scale(QoR-40)24 h after operation were used to evaluate postoperative pain and recovery after childbirth,and maternal heart rate(HR),blood oxygen saturation(SpO_(2)),level of prolactin secretion,mean arterial pressure(MAP),the number of effective compression,and incidence of adverse reactions were recorded.Results The VAS scores of 6,12 and 24 h after operation were higher than those of 2 h,VAS score 12 h after surgery was higher than 6 h after surgery,and VAS score 24 h after surgery was lower than that of 6 and 12 h after surgery,and the differences were statistically significant(P<0.05).VAS scores of the group B at 6,12 and 24 h after operation were lower than those of group A,the differences were statistically significant(P<0.05).Compared with before operation,MAP and SpO_(2) decreased and HR increased in both groups at 8 h after operation,but HR of the group B at 8 h after operation was lower than the group A,and SpO_(2) level was higher than group A,the differences were statistically significant(P<0.05).The secretion levels of prolactin in two groups at 12,24 and 48 h after operation were higher than those at conclusion of operation,the prolactin level at 48 h after operation was higher than that at 12 and 24 h after operation,and prolactin level at 24 h after operation was higher t

关 键 词：右美托咪定 芬太尼 剖宫产 罗哌卡因 术后镇痛 腹横肌平面阻滞 

分 类 号：R614.4[医药卫生—麻醉学] R61[医药卫生—外科学]