超声引导下椎管内麻醉联合腹横肌平面神经阻滞对超体重产妇剖宫产术后康复的影响  

Influence of ultrasound-guided intraspinal anesthesia combined with transversus abdominis plane nerve block on rehabilitation of overweight pregnant women after cesarean section

作　　者：李云祥 朱雅斌 邢海林 刘新法 乔庆成 韦静 尹明 张传猛 姜琳 LI Yun-xiang;ZHU Ya-bin;XING Hai-lin;LIU Xin-fa;QIAO Qing-cheng;WEI Jing;YIN Ming;ZHANG Chuan-meng;JIANG Lin(Department of Anesthesiology,the Affiliated Taizhou People's Hospital of Nanjing Medical University,Taizhou,Jiangsu 225300,China;Department of Obstetrics,the Affiliated Taizhou People's Hospital of Nanjing Medical University,Taizhou,Jiangsu 225300,China;Department of Medical Ultrasound,the Affiliated Taizhou People's Hospital of Nanjing Medical University,Taizhou,Jiangsu 225300,China;Central Laboratory,the Affiliated Taizhou People's Hospital of Nanjing Medical University,Taizhou,Jiangsu 225300,China)

机构地区：[1]南京医科大学附属泰州人民医院麻醉科,江苏泰州225300 [2]南京医科大学附属泰州人民医院产科,江苏泰州225300 [3]南京医科大学附属泰州人民医院超声医学科,江苏泰州225300 [4]南京医科大学附属泰州人民医院中心实验室,江苏泰州225300

出　　处：《中华实用诊断与治疗杂志》2023年第1期64-69,共6页Journal of Chinese Practical Diagnosis and Therapy

基　　金：江苏省妇幼健康科研项目(F201934)。

摘　　要：目的观察超体重(孕前体质量指数≥25kg/m^(2))产妇剖宫产术中应用超声引导下椎管内麻醉联合腹横肌平面神经阻滞的效果,探讨其在术后康复中的作用。方法行剖宫产手术超体重产妇240例,随机分为观察组和对照组各120例。对照组椎管内麻醉采用常规髂嵴最高点连线定位法,于L_(2-3)间隙穿刺后注射质量分数0.75%布比卡因1.2~1.5mL;观察组在超声引导下于L_(2-3)间隙穿刺后注射质量分数0.75%布比卡因1.2~1.5mL,手术结束时于超声引导下行双侧腹横肌平面神经阻滞,注射质量分数0.375%盐酸罗哌卡因15mL+盐酸右美托咪定0.75μg/kg;2组术后自控静脉镇痛均应用舒芬太尼+酮洛酸氨丁三醇+盐酸阿扎司琼。记录2组麻醉穿刺时间、穿刺次数、首次自控镇痛时间、自控镇痛次数、术后泌乳时间、住院时间等;采用40项恢复质量量表(quality of recovery-40questionnaire,QoR-40)评分评估2组术后24h恢复情况;比较2组术前及术后24h催乳素、空腹血糖、去甲肾上腺素、白细胞介素-6(interleukin 6,IL-6)水平;多因素线性回归分析影响超体重产妇剖宫产术后QoR-40评分的因素。结果2组年龄、孕周、体质量指数、手术时间及术后下床时间比较差异均无统计学意义(P>0.05)。观察组麻醉穿刺时间[(78.1±20.2)s]、术后泌乳时间[(25.3±10.2)h]、术后通气时间[(10.7±6.1)h]、住院时间[(4.8±0.8)d]均短于对照组[(117.6±79.1)s、(33.1±12.9)h、(12.8±9.4)h、(5.0±0.8)d](t=5.300,P<0.001;t=5.177,P<0.001;t=2.046,P=0.040;t=2.023,P=0.040),穿刺次数[(1.3±0.5)次]、自控镇痛次数[(1.9±1.3)次]均少于对照组[(1.8±0.9)、(2.8±1.6)次](t=5.610,P<0.001;t=4.893,P<0.001),术后24hQoR-40评分[(192.0±9.8)分]高于对照组[(180.1±21.8)分](t=5.443,P<0.001)。观察组术前24h空腹血糖[5.20(4.50,5.60)mmol/L]、去甲肾上腺素[442.50(382.25,462.00)ng/L]、IL-6[5.37(4.56,5.90)ng/L]、催乳素[226.00(206.25,245.00)μg/L]水平与对照组[5.20(Objective To observe the effect of ultrasound-guided intraspinal anesthesia combined with nerve block in the transversus abdominis plane during cesarean section in overweight pregnant women with body mass index>25kg/m^(2) before pregnancy,and to explore its role in postoperative rehabilitation.Methods A total of 240overweight pregnant women scheduled for cesarean section were randomly and equally divided into observation group and control group.Control group received intraspinal anesthesia by conventional iliac crest line location,and was injected with 1.2to 1.5mL of 0.75%bupivacaine after puncture in L_(2-3)space.Observation group was injected with 1.2to 1.5mL of 0.75%bupivacaine after puncture in L_(2-3)space,and was given bilateral nerve block in the transversus abdominis plane with 15mL of 0.375%ropivacaine+0.75μg/kg dexmedetomidine under ultrasound guidance after operation.Sufentanil+ketorolac tromethamine+azasetron hydrochloride was used in both groups for self-control analgesia.The time of anesthesia puncture,puncture frequency,time of first self-control analgesia,frequency of self-control analgesia,time of lactation after operation and length of hospital stay were compared between two groups.A quality of recovery-40 questionnaire(QoR-40)score was used to evaluate the recovery of two groups in 24hafter operation.The levels of prolactin,fasting plasma glucose,norepinephrine and interleukin-6(IL-6)were compared before and 24hafter operation between two groups.Multivariate linear regression analysis was done to assess the influencing factors of QoR-40score after cesarean section in overweight pregnant women.Results There were no significant differences in the age,gestational week,body mass index,operation lasting time and time to off-bed exercise after operation between two groups(P>0.05).The anesthesia puncture time,lactation time after operation,exhaust time after operation,and length of hospital stay were shorter in observation group[(78.1±20.2)s,(25.3±10.2)h,(10.7±6.1)h,(4.8±0.8)d]than those in contr

关 键 词：剖宫产术 椎管内麻醉 腹横肌平面神经阻滞 40项恢复质量量表评分 快速康复 

分 类 号：R614[医药卫生—麻醉学]