罗哌卡因复合芬太尼腹横肌平面阻滞对剖宫产产妇术后疼痛、血流动力学及泌乳功能的影响

Influence of transversus abdominis plane block with ropivacaine plus fentanyl on postoperative pain,hemodynamics and lactation function in puerperas with cesarean section

目的探讨罗哌卡因复合芬太尼腹横肌平面阻滞(TAPB)对剖宫产产妇术后疼痛、血流动力学及泌乳功能的影响。方法将本院产科拟行剖宫产手术的150例产妇随机分为复合组与对照组,对照组手术结束后给予静脉自控镇痛(PCIA),复合组在对照组基础上给予双侧TAPB。比较2组产妇不同时点视觉模拟(VAS)评分、血流动力学指标、初乳时间、血清泌乳素水平及新生儿阿氏(Apgar)评分、神经行为评分。结果复合组各时点VAS评分及有效按压次数均显著低于对照组(P <0. 05)。复合组术后8 h心率显著低于对照组(P <0. 05),2组平均动脉压、血氧饱和度比较均无显著差异(P>0. 05)。复合组初乳时间显著早于对照组(P <0. 05),术后24、48 h血清泌乳素水平显著高于对照组(P <0. 05)。2组新生儿Apgar、神经行为评分比较均无显著差异(P> 0. 05)。结论剖宫产产妇术后应用罗哌卡因复合芬太尼双侧TAPB的镇痛效果较好,可缩短初乳始动时间,产妇血流动力学更稳定,且对新生儿无明显负面影响。

Objective To investigate the influence of transversus abdominis plane block(TAPB)with ropivacaine plus fentanyl on postoperative pain,hemodynamics and lactation function in puerperas with cesarean section.Methods Totally 150 puerperas with proposed cesarean section were randomly divided into combined group and control group.The control group was conducted with patient-controlled intravenous analgesia(PCIA)after surgery,while the combined group was conducted with bilateral TAB on the basis of control group.The VAS score,hemodynamic parameters,colostrum time,serum prolactin level,Apgar score and neurobehavioral score at different time points were compared between the two groups.Results The VAS score and effective pressing times at each time point in the combined group were significantly lower than those in the control group(P<0.05).The heart rate at 8 hours after operation in the combined group was significantly lower than that in the control group(P<0.05).There were no significant differences in mean arterial pressure and oxygen saturation between the two groups(P>0.05).The colostrum time of the combined group was significantly earlier than that of the control group(P<0.05),and the serum prolactin levels at 24 and 48 hours after operation were significantly higher than those of the control group(P<0.05).There were no significant differences in Apgar and neurobehavioral scores between the two groups(P>0.05).Conclusion It is better for puerperas to implement bilateral TAPB with ropivacaine plus fentanyl after cesarean section,which can shorten the start time of colostrum,stabilize maternal hemodynamics,and cause less negative impact for neonates.