超声引导腹横肌平面阻滞在剖宫产全麻术后镇痛中的运用

A Clinical Research of Postoperative Pain Control by Ultrasound-guided transversusabdominis Plane Blocks After Cesarean Delivery Under General Anesthesia

目的拟验证超声引导腹横肌平面(transversus abdominal plane,TAP)阻滞在剖宫产全麻后的镇痛疗效。方法实施全麻剖宫产并且愿意接受术后镇痛的产妇40例,分为TAP+PCIA(patient controlled intravenous analgesia)组与单纯PCIA组。胎儿娩出后均接静脉电子镇痛泵。在手术结束后实施超声引导下TAP。观察并记录48 h内各随访时点的NRS(运动与静息时),镇痛泵使用时间,按压次数(D1),实际进入次数(D2),产妇满意度评分。镇痛相关并发症:呕吐,瘙痒,嗜睡。结果 TAP+PCIA组在术后24h内的时间点的NRS评分明显低于PCIA组(P<0.05),而24h后两组差异不明显(P>0.05);镇痛泵使用时间TAP+PCIA组长于PCIA组(P<0.05),而D1/D2低于PCIA组(P<0.05),产妇满意度两组近似(P>0.05)。两组镇痛相关并发症发生率无统计学意义(P>0.05)。结论超声引导下腹横肌平面阻滞复合静脉镇痛可以产生较单纯静脉镇痛更为良好的产科术后镇痛。

Objective To compared the analgesic efficacy of TAP（transversus abdominal plane）blocks after cesarean de- livery（CD） after general anesthesia. Methods 40 cases of parturients who willing to accept postoperative pain manage were en- rolled and divided into TAP ＋ PCIA（ patient controlled intravenous analgesia）group and the purely PCIA group. After delivery of the fetus, the two groups of patients received intravenous electronic analgesia pump. Quality of the patients＇pain was evaluated by NRS （numerical rating scale） at rest and movement, and maternal satisfaction score, still using the NRS. The demographic data and and incidence of analgesia-related complications： vomiting, pruritus, somnolence after CD in 48h were recorded in both groups. Results Postoperative within 24 h in TAP ＋ PCIA group, NRS movement and at rest scores were significantly lower than PCIA group （ P 〈 0. 05 ）, but there was no difference between groups after 24h（ P 〉 0. 05 ）. The maternal satisfaction and analge- sia-related complications in two groups had no difference （P 〉 0.05 ）. Use of time of analgesia pump in TAP ＋ PCIA group longer than in the PCIA group （ P 〈 0.05 ）, but D1 / D2 in TAP ＋ PCIA group were lower than the PCIA group （ P 〈 0.05 ）. Conclu- sion Ultrasound-guided transversus abdominal plane block combined with patient controlled intravenous analgesia could provide a better obstetric analgesia.