腹横肌平面阻滞联合CSEA在有剖宫产史者再次剖宫产术中的应用  

Application of transversus abdominis plane block combined with continuous spinal epidural anesthesia in cesarean section for patients with previous cesarean section

作　　者：樊磊[1] 张小伟 吕志峰[3] FAN Lei;ZHANG Xiao-wei;LV Zhi-feng(Department of Anesthesiology,Zhengzhou Maternal and Child Health Hospital,Zhengzhou 450012,Henan,CHINA;Department of Anesthesiology,Zhengzhou Central Hospital,Zhengzhou 450016,Henan,CHINA;Department of Anesthesiology,the First Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou 450000,Henan,CHINA)

机构地区：[1]郑州市妇幼保健院麻醉科,河南郑州450012 [2]郑州市中心医院麻醉科,河南郑州450016 [3]河南中医药大学第一附属医院麻醉科,河南郑州450000

出　　处：《海南医学》2025年第3期371-376,共6页Hainan Medical Journal

基　　金：2020年河南省中医药科学研究专项项目(编号:20-21ZY21970)。

摘　　要：目的分析腹横肌平面(TAP)阻滞联合腰硬麻醉(CSEA)在有剖宫产史者再次剖宫产术中的麻醉效果。方法选取2023年7月至2024年4月郑州市妇幼保健院收治的98例有剖宫产史再次择期拟行剖宫产术孕产妇作为研究对象,按随机数表法分为CSEA组和联合组各49例。CSEA组孕产妇采用CSEA,联合组孕产妇先予以TAP阻滞,再采用CSEA。比较两组孕产妇的麻醉起效时间、手术时间、术中出血量和入室至返回病房时间;比较两组孕产妇术中不同时间点(切皮时、胎儿娩出时、切子宫肌层时、缝合子宫切口时、关闭腹部切口时)疼痛视觉模拟量表(VAS)评分,术中各时间点(入室时、切皮时、胎儿娩出时、关闭腹部切口时)循环指标[心率(HR)、平均动脉压(MAP)],术后不同时间点(6 h、12 h、24 h)静息状态VAS评分,初次及第二次按压子宫时VAS评分;比较两组孕产妇术后24 h静脉自控镇痛(PCIA)按压次数、泌乳情况(初始泌乳时间、48 h泌乳量)及不良反应总发生率。结果联合组孕产妇的麻醉起效时间、入室至返回病房时间分别为(2.60±0.75)min、(147.62±19.30)min,明显短于CSEA组的(4.00±0.58)min、(155.40±16.17)min,差异均有统计学意义(P<0.05);两组孕产妇的手术时间、术中出血量比较差异均无统计学意义(P>0.05);联合组孕产妇术中不同时间点的VAS评分明显低于CSEA组,差异均有统计学意义(P<0.05);两组孕产妇入室时、切皮时、胎儿娩出时、关闭腹部切口时的HR、MAP比较差异均无统计学意义(P>0.05);联合组孕产妇术后6 h、12 h、24 h静息状态下的VAS评分明显低于CSEA组,初次、第二次按压子宫时的VAS评分明显低于CSEA组,差异均有统计学意义(P<0.05);联合组孕产妇术后24 h PCIA按压次数为(4.89±1.51)次,明显少于CSEA组的(7.25±2.38)次,初始泌乳时间为(19.94±6.28)h,明显早于CSEA组的(38.82±9.67)h,差异均有统计学意义(P<0.05);联合组孕产妇的不良反应�Objective To analyze the anesthetic effect of transversus abdominis plane(TAP)block combined with continuous spinal epidural anesthesia(CSEA)in cesarean section for patients with a history of cesarean section.Methods A total of 98 pregnant women with a history of cesarean section who were admitted to Zhengzhou Maternal and Child Health Hospital from July 2023 to April 2024 and were scheduled for cesarean section again were selected as the research subjects.The patients were divided into CSEA group and combined group by random number table method,with 49 cases in each group.Patients in the CSEA group were given CSEA,and those in the combined group were given TAP block first and then CSEA.The onset time of anesthesia,operation time,intraoperative blood loss,and time from entering the Operating Room to returning to the ward were compared between the two groups.The Visual Analogue Scale(VAS)scores of pain at different time points during the operation(skin incision,fetal delivery,uterine muscle layer incision,uterine incision suturing,abdominal incision closure),the circulating indicators(heart rate[HR],mean arterial pressure[MAP])at each time point during the operation(room entry,skin incision,fetal delivery,abdominal incision closure),the VAS scores at different time points after surgery(6 h,12 h,24 h)in a resting state,and the VAS scores during the first and second uterine compression were compared between the two groups of pregnant women.The number of postoperative 24-hour patient-controlled intravenous analgesia(PCIA)compressions,lactation status(initial lactation time,48-hour milk production),and overall incidence of adverse reactions were compared between the two groups of pregnant women.Results The onset time of anesthesia and time from entering the Operating Room to returning to the ward in the combined group were(2.60±0.75)min and(147.62±19.30)min,respectively,which were significantly shorter than(4.00±0.58)min and(155.40±16.17)min in the CSEA group(P<0.05).There was no significant difference in the oper

关 键 词：剖宫产 腹横肌平面阻滞 腰硬联合麻醉 镇痛效果 循环指标 不良反应 

分 类 号：R719.8[医药卫生—妇产科学]