超声引导下腹横肌阻滞联合舒芬太尼加地佐辛对剖宫产孕妇术后镇痛效果及IL-10因子水平的影响观察

Observation on the effect of ultrasound-guided transverse abdominal muscle block combined with sufentanil and dizosin on analgesia and IL-10 level after cesarean section

目的研究超声引导下腹横肌阻滞(TAP)联合舒芬太尼联合地佐辛静脉镇痛(PCIA)在剖宫产孕妇术后镇痛效果及IL-10因子水平的影响。方法选取常州市武进中医医院2015年1月至2018年7月剖宫产分娩孕妇100例为研究对象,根据术后镇痛方法的不同分为对照组及观察组,其中对照组50例采用舒芬太尼联合地佐辛(PCIA)镇痛,观察组在此基础上加用超声引导下腹横肌阻滞镇痛治疗,评价两组孕妇术后2h、6h、8h、24h各时间点的视觉模拟程度评分(VAS),并记录血清IL-10浓度。结果在术后镇痛效果上进行对比,观察组镇痛后2h[(4.25±0.25)分比(4.85±0.24)分]、6h[(4.05±0.14)分比(4.72±0.11)分]、8h[(3.95±0.12)分比(4.52±0.22)分]、24h[(3.24±0.21)分比(3.98±0.18)分]评分均明显小于对照组,差异均有统计学意义(均P<0.05)。在镇痛药量上对比,观察组孕妇术后3h[(4.05±1.26)分比(5.34±1.05)分]、6h[(3.26±0.14)分比(4.68±1.36)分]、8h[(2.68±0.15)分比(3.48±1.03)分]、24h[(0.12±0.02)分比(1.32±0.14)分]PCLA镇痛追加镇痛药量均明显小于对照组,差异均有统计学意义(均P<0.05)。观察组与对照组孕妇IL-10浓度镇痛前30min比较,差异无统计学意义[(18.26±2.47)分比(18.57±2.36)分,P>0.05]。观察组孕妇IL-10浓度镇痛后2h[(21.56±5.24)分比(33.58±5.14)分]、分娩后24h[(29.51±4.28)分比(50.26±4.17)分]、48h[(22.54±4.26)分比(46.25±3.27)分]IL-10浓度均明显小于对照组,差异均有统计学意义(均P<0.05)。结论TAP联合PCIA镇痛方案的应用有助于进一步提升镇痛效果,且安全性较高,同时可降低孕妇血清IL-10因子水平。

Objective To study the effects of ultrasound-guided transverse abdominis blockade(TAP)combined with sufentanil combined with dexamethasone intravenous analgesia(PCIA)on postoperative analgesia and IL-10 level in pregnant women undergoing cesarean section.Methods A total of 100 pregnant women with cesarean delivery from January 2015 to July 2018 in Changzhou Wujin Chinese Medicine Hospital were selected as the study subjects.The control group was divided into the control group and the observation group according to the postoperative analgesia method.Fentanyl combined with dextrozine(PCIA)analgesia,the observation group on the basis of ultrasound-guided abdominal abdominis block analgesia treatment,evaluation of the two groups of pregnant women at 2 h,6 h,8 h,24 hafter surgery The simulated degree score(VAS)was recorded and serum IL-10 concentrations were recorded.Results The postoperative analgesic effect was compared.The observation group was2 hafter analgesia[(4.25±0.25)points(4.85±0.24)points],6 h[(4.05±0.14)points(4.72±0.11)points,The scores of 8 h[(3.95±0.12)(4.52±0.22)]and 24 h[(3.24±0.21)(3.98±0.18)]were significantly lower than the control group,and the differences were statistically significant(both P<0.05).In the comparison of the analgesic dose,the pregnant women in the observation group were 3 h[(4.05±1.26)points(5.34±1.05)points,6 h[(3.26±0.14)points(4.68±1.36)points,8 h[(2.68±0.15)(3.48±1.03)points,24 h[(0.12±0.02)(1.32±0.14)points]PCLA analgesic additional analgesic doses were significantly lower than the control group,the difference was statistically significant.(all P<0.05).There was no significant difference between the observation group and the control group in the IL-10 concentration 30 minutes before analgesia[(18.26±2.47)points(18.57±2.36)points,P>0.05].The IL-10 concentration in the observation group was 2 hafter analgesia[(21.56±5.24)points(33.58±5.14)points],24 hafter delivery[(29.51±4.28)points(50.26±4.17)points],48 h[The concentration of IL-10 was significantly lower than that of the control group(22.54±4.26)points(46.25±3.27)points].The difference was statistically significant(P<0.05).Conclusion The application of TAP combined with PCIA analgesia can help to further improve the analgesic effect,and it is safer and can reduce the serum IL-10 level of pregnant women.