超声引导下连续腹横肌平面阻滞与持续硬膜外镇痛在剖宫产术后

Effect Comparison between Ultrasound-guided Continuous Transverses Abdominis Plane Block and Continuous Epidural Analgesia in Postoperative Analgesia of Cesarean Section

目的比较超声引导下连续腹横肌平面阻滞(Transversus Abdominal Plane,TAP)与持续硬膜外镇痛(Continuous Epidural Analgesia,CEA)在剖宫产术后镇痛中的疗效。方法实施腰硬联合麻醉下剖宫产单胎足月并且愿意接受术后镇痛的产妇120例。计算机排序随机分为TAP组与CEA组,各60例。在手术结束后分别对两组产妇实施超声引导下TAP及CEA。观察并记录48小时内各随访时点的疼痛评分(Visual An-alogue Scale,VAS),产妇满意度评分,48小时内辅助镇痛药使用率,镇痛相关并发症:术后低血压,恶心呕吐,下肢感觉运动障碍,尿潴留,皮肤瘙痒,嗜睡。结果 48小时内,两组产妇术后VAS评分随着时间的推移不断下行,各时点运动状态下VAS评分均高于静息状态,但两组运动及静息状态下的VAS评分差异均无统计学意义(P>0. 05)。各组产妇满意度评分无统计学差异(P>0. 05)。48小时内辅助镇痛药使用率各组之间无差异(P>0. 05),CEA组术后低血压发生率,恶心呕吐率,下肢感觉运动障碍发生率及尿潴留发生率明显高于TAP组,差异有统计学意义(P<0. 05)。皮肤瘙痒及嗜睡发生率两组无差别(P>0. 05)。结论超声引导下连续腹横肌平面阻滞与持续硬膜外镇痛在剖宫产术后镇痛中均有确切的疗效,但相较于传统硬膜外镇痛而言,超声引导下连续腹横肌平面阻滞的不良反应发生率更低。

Objective To compare the effects of ultrasound-guided transversus abdominal place(TAP)block and continuous epidural analgesia(CEA)in postoperative analgesia of cesarean section.Methods 120 parturients undergoing cesarean section under combined spinal anesthesia,who were willing to accept postoperative pain manage,were randomly divided into 2 groups:TAP group and CEA group,60 in each;after cesarean section,TAP block was performed on cases in TAP group while CEA on cases in CEA group;observation and recording were made to the scores of visual analogue scale(VAS)within 48 hours at the time point of each follow-up,satisfaction of the cases in each group,the application rate of adjuvant analgesic drugs within 48 hours and the incidence of complications related to analgesia including postoperative hypotension,nausea and vomiting,sensorimotor disorder of lower limbs,urine retention,skin pruritus and drowsiness.Results The postoperative VAS scores in the 2 groups kept decreasing with time going and were higher at each time point of motion state within 48 hours than those of resting state while the difference between the scores of motion state and those of rest state was of no statistical significance in both groups(P>0.05);the scores of satisfaction,the application rate of adjuvant analgesic drugs within 48 hours and the occurrence of skin pruritus and drowsiness in the 2 groups were of no statistical differences(P>0.05);the incidence of postoperative hypotension,nausea and vomiting,sensorimotor disorder of lower limbs and urine retention was much higher in CEA group than in TAP group(P<0.05).Conclusions Ultrasound-guided TAP block and CEA are both of definite effect in postoperativea analgesia of cesarean section and TAP leads to a lower occurrence of complications than CEA.