后入路TAPB联合RSB对剖宫产术后患者的镇痛效果及对其血流动力学指标和胎儿的影响评估  

Evaluation of analgesic effect of posterior approach TAPB combined with RSB in patients after cesarean section and its effect on hemodynamic indices and fetus

作　　者：胡鑫 赵王成 高赛 王文耀 HU Xin;ZHAO Wang-cheng;GAO Sai;WANG Wen-yao(Department of Anesthesiology,3201 Hospital,Hanzhong 723012,Shaanxi,China)

机构地区：[1]三二〇一医院麻醉科,陕西汉中723012

出　　处：《生物医学工程与临床》2023年第5期633-637,共5页Biomedical Engineering and Clinical Medicine

摘　　要：目的探讨后入路腹横肌平面阻滞(TAPB)联合腹直肌鞘阻滞(RSB)对剖宫产术后患者的镇痛效果及对其血流动力学指标和胎儿的影响。方法选择三二〇一医院98例行剖宫产术的产妇,年龄25~32岁,平均年龄28.7岁;孕周38~40周,平均孕周39.4周;身体质量指数(BMI)21.4~24.9 kg/m2,平均BMI 22.9 kg/m2;美国麻醉医师协会(ASA)分级,Ⅰ级40例,Ⅱ级58例。依据镇痛手段的不同分成2组,即研究组(40例)、对照组(58例)。研究组实施后入路TAPB联合RSB治疗,对照组实施侧入路TAPB联合RSB治疗。比较两组患者的镇痛、镇静、并发症、血流动力学[心率(HR)、平动脉压(MAP)]情况,分析对胎儿安全性。结果麻醉前两组镇痛及镇静情况比较,差异无统计学意义(P>0.05),而术后两组的镇痛及镇静情况均较术前有所改善,且研究组优于对照组(P<0.05)。两组术后并发症发生率比较(10.0%vs 12.0%),差异无统计学意义(P>0.05)。麻醉前两组血流动力学相关指标对比,差异无统计学意义(P>0.05);术后两组HR较麻醉前略有升高,且研究组HR升高低于对照组,而MAP下降明显,且研究组MAP下降多于对照组,差异均有统计学意义(P<0.05)。术后,两组新生儿Apgar评分比较(9.5分±1.5分vs 9.3分±1.8分),差异无统计学意义(P>0.05)。结论后入路TAPB联合RSB对剖宫产术后患者的镇痛效果较佳,同时能够稳定患者的血流动力学指标,并不影响术后并发症的发生及新生儿的生命体征,值得临床推广应用。Objective To investigate the analgesic effect of posterior approach transversus abdominis plane block(TAPB)combined with rectus sheath block(RSB)in patients after cesarean section and its effect on hemodynamic indices and fetus.Methods A total of 98 pregnant women who underwent cesarean section were enrolled,which aged 25-32 years old with mean age of 28.7 years old;gestational weeks was 38-40 weeks with mean of 39.4 weeks;body mass index(BMI)was 21.4-24.9 kg/m2 with mean BMI of 22.9 kg/m2.According to the American Society of Anesthesiologists(ASA)classification,there were 40 cases of grade I and 58 cases of grade II.All of them were divided into 2 groups by difference analgesia modality,included study group(n=40,performed posterior approach TAPB combined with RSB)and control group(n=58,underwent lateral approach TAPB combined with RSB).The analgesia,sedation,complications,and hemodynamics[heart rate(HR),mean arterial pressure(MAP)]of 2 groups were compared,and the safety of two method on fetus was analyzed.Results There was no significant difference in analgesia and sedation before operation between 2 groups(P>0.05),while after operation,of the above parameters in 2 groups were improved compared with those of before operation,and study group was superior than control group(P<0.05).There was no significant difference in incidence of postoperative complications between 2 groups(10.0%vs 12.0%)(P>0.05).There was no significant difference in hemodynamic indexes before operation between 2 groups(P>0.05).The HR of 2 groups after operation was slightly higher than that of before operation,and HR of study group was significantly lower than that of control group(P>0.05).However,the MAP was significantly decreased after operation than before operation,and the study group was higher than that of control group,the differences were statistically significant(P<0.05).There was no significant difference in neonatal Apgar score after operation between 2 groups(9.5 scores±1.5 scores vs 9.3 scores±1.8 scores.P>0.05).Conclusion It

关 键 词：入路 腹横肌平面阻滞 腹直肌鞘阻滞 剖宫产 镇痛效果 血流动力学指标 

分 类 号：R614[医药卫生—麻醉学]