PCIA联合不同区域神经阻滞用于剖宫产术镇痛及对产妇血流动力学和新生儿影响  

Analgesic effect of patient-controlled intravenous analgesia combined with different regional nerve blocks for treating women with cesarean section and its influences on their hemodynamics and neonates

作　　者：倪俊 王叶龙 徐旭然 NI Jun;WANG Yelong;XU Xuran(Nanjing Gaochun People's Hospital,Nanjing,Jiangsu Province,211300)

机构地区：[1]江苏省南京市高淳人民医院,211300

出　　处：《中国计划生育学杂志》2023年第10期2380-2383,共4页Chinese Journal of Family Planning

摘　　要：目的:探讨自控静脉镇痛(PCIA)联合不同区域神经阻滞对剖宫产术镇痛效果及对血流动力学和新生儿影响。方法:选取2019年1月-2021年9月拟于本院行腰-硬联合麻醉下剖宫产手术产妇86例,根据术后镇痛方案分为3组,A组(31例)采用PCIA联合前层胸腰筋膜下阻滞,B组(26例)采用PCIA联合前层胸腰筋膜外阻滞,C组(29例)采用PCIA联合腹横肌阻滞,分析3组术后镇痛效果。结果:A组、B组、C组镇痛泵首次应用时间逐渐减少(26.3±1.2h、21.5±1.5h、14.9±1.0h),24h内镇痛泵按压次数(4.2±0.8次、5.7±1.1次、7.9±1.6次)、首次下床活动时间(5.0±1.1h、5.9±1.3h、6.8±1.5h)、初乳时间(20.8±2.5h、25.2±2.8h、31.8±3.2h)及芬太尼应用量(0.5±0.1mg、0.7±0.1mg、0.8±0.1mg)逐渐增加(P<0.05);术后24h疼痛评分静息(1.0±0.2分、1.3±0.4分、1.7±0.6分)及运动状态(1.1±0.3分、1.5±0.4分、1.9±0.8分)均逐渐升高,平均动脉压(80.2±5.3mmHg、83.6±7.1mmHg、89.5±9.6mmHg)及心率(78.6±7.6次/分、85.5±8.3次/分、93.1±11.0次/分)均逐渐升高,不良反应率(3.2%、23.1%、51.7%)逐渐增加(均P<0.05);新生儿5min Apgar评分(9.2±1.2分、9.4±1.4分、9.5±1.1分)无差异(P>0.05)。结论:PCIA联合前层胸腰筋膜下阻滞对剖宫产产妇镇痛效果最佳,且对血流动力学相关指标影响最小,不增加术后不良反应。Objective:To investigate the analgesic effect of patient-controlled intravenous analgesia(PCIA) combined with different regional nerve blocks for treating women with cesarean section,and to study its influences on the hemodynamics of the women and on the neonates.Methods:86 women who had undergone cesarean section from January 2019 to September 2021 were selected and were divided into three groups based on the different postoperative analgesic protocols.31 women in group A were treated with PCIA combined with anterior thoracolumbar subfascial block,26 women in group B were treated with PCIA combined with anterior thoracolumbar extrafascial block,and 29 women in group C were treated with PCIA combined with transversus abdominis block.The postoperative analgesic efficacy of the women in the three groups was analyzed.Results:The first application time of the analgesic pump of the women in group A,group B,and group C were 26.3±1.2h,21.5±1.5h,and 14.9±1.0h,respectively,which had decreased gradually.The number of analgesic pump compression of the women in group A,group B,and group C within postoperative 24h were 4.2±0.8times,5.7±1.1times,and 7.9±1.6times,respectively,the first time of getting out of bed of the women in group A,group B,and group C were 5.0±1.1h,5.9±1.3h,and 6.8±1.5h,respectively,the time of colostrum of the women in group A,group B,and group C were 20.8±2.5h,25.2±2.8h,31.8±3.2h,respectively,and the fentanyl dosage used of the women in group A,group B,and group C were 0.5±0.1mg,0.7±0.1mg,and 0.8±0.1mg,respectively,and all of which had increased gradually(P<0.05).The pain scores of the women in group A,group B,and group C in postoperative 24h at rest were 1.0±0.2 points,1.3±0.4 points,and 1.7±0.6 points,respectively,and the pain scores of the women in group A,group B,and group C in postoperative 24hat action were1.1±0.3points,1.5±0.4points,and 1.9±0.8points,respectively,the mean arterial pressure value of the women in group A,group B,and group C were 80.2±5.3mmHg,83.6±7.1mmHg,and 89

关 键 词：剖宫产 镇痛 自控静脉镇痛 腹横肌平面阻滞 腰方肌阻滞 血流动力学 新生儿 

分 类 号：R614[医药卫生—麻醉学] R719.8[医药卫生—外科学]