三种不同镇痛方式用于剖宫产术后镇痛的效果

Efficacy of three different analgesic methods for postoperative analgesia in patients undergoing cesarean section

目的评价三种不同镇痛方式用于剖宫产术后镇痛的效果。方法选取2017年3～12月武汉大学中南医院收治的90例择期行剖宫产术的产妇为研究对象,所有产妇均在硬膜外和脊髓联合麻醉下行剖宫产。采用随机数字表法将其分为连续硬膜外自控镇痛组(PCEA组)、静脉自控镇痛组(PCIA组)、连续腹横肌平面阻滞组(CTAP组),每组30例。PCEA组术后经硬膜外导管输注0.375%罗哌卡因,负荷剂量2 m L,背景输注2 m L/h,单次按压剂量2 m L,锁定时间15 min;PCIA组术后静脉泵注1μg/m L舒芬太尼+50μg/m L托烷司琼,负荷剂量2 m L,背景输注2 m L/h,单次按压剂量2 m L,锁定时间15 min;CTAP组术后经导管向腹横筋膜间隙内输注0.375%罗哌卡因,负荷量20 m L/侧,背景输注6～8 m L/h,单次病人自控镇痛(PCA)剂量6～8 m L,锁定时间60 min。各组术后镇痛均持续72 h。若静息疼痛视觉模拟评分(VAS)≥4分则肌内注射曲马多100 mg进行补救镇痛。记录产妇术后即刻、2、6、12、24、36、48、72 h静息和运动时的VAS评分、舒适度评分(BCS)、补救镇痛率、人均曲马多消耗量、术后肛门排气时间、双下肢抬离床面时间及镇痛相关并发症。结果与PCIA组比较,PCEA组和CTAP组术后6、12、24、36、48 h时静息和运动状态的VAS评分较低,BCS评分较高,差异有统计学意义(P<0.05),补救镇痛率低,人均曲马多消耗量少,肛门排气时间缩短,镇痛相关并发症发生率低,差异有统计学意义(P<0.05);PCEA组及CTAP组术后各时间点运动状态的VAS评分、BCS评分、补救镇痛率、人均曲马多消耗量、肛门排气时间及镇痛相关并发症总发生率比较,差异无统计学意义(P>0.05),但CTAP组双下肢抬离床面时间较PCEA组缩短(P<0.05)。结论与PCIA和PCEA比较,CTAP在剖宫产术中镇痛效果更好,不良反应发生率更低,并发症最少。

Objective To evaluate the efficacy of three different analgesic methods when used for postoperative analgesia in patients undergoing cesarean section. Methods A total of 90 parturients scheduled for elective cesarean section in Zhongnan Hospital of Wuhan University, from March to December 2017 were selected as research subjects. All parturients underwent cesarean delivery under combined spinal and epidural anesthesia. They were divided into patientcontrolled epidural analgesia group(PCEA group), patient-controlled intravenous analgesia group(PCIA group) and continuous transversus abdominis plane block group(CTAP group) according to the random number table method, with30 cases in each group. In PCEA group, the patients received PCEA with 0.375% Ropivacaine 2 mL after surgery, and the PCEA pump was set up to deliver a 2 mL bolus dose, a 15 min lockout interval and background infusion at a rate of 2 mL/h. In PCIA group, the patients received PCIA with Sufentanil 1 μg/mL + Tropisetron 50 μg/mL mixture 2 mL after surgery, and the PCIA pump was set up to deliver a 2 mL bolus dose, a 15 min lockout interval and background infusion at a rate of 2 mL/h. In CTAP group, bilateral TAP block was performed with 0.375% Ropivacaine 20 m L under ultrasound guidance and 0.375% Ropivacaine 6-8 mL/h was infused into bilateral TAPs by pump after surgery, the pump was set up to deliver a 6-8 mL bolus dose, a 60 min lockout interval. Analgesia lasted until 72 h after operation in all groups. When resting visual analog scale(VAS)scores≥4, Tramadol 100 mg was injected intravenously as rescue analgesia. The resting and moving VAS and Bruggrmann comfort scale(BCS) scores were recorded at immediately after the end of operation and at 2, 6, 12, 24, 36, 48, 72 hours after operation, the rate of rescue analgesia,dosage of Tramadol, the recovery time of postoperative intestinal function and lower limb motor function, and the incidence of adverse reactions were also recorded within 72 h after operation. Results Compared with PCIA group, the resting and moving VAS scores were lower and the BCS scores were higher at 6, 12, 24, 36, 48 hours after operation in PCEA group and CTAP group, the differences were statistically significant(P < 0.05), and the rate of rescue analgesia,dosage of Tramadol, recovery time of postoperative intestinal function and the incidence of adverse reactions were lower in PCEA group and CTAP group, the differences were statistically significant(P < 0.05). There were no significant differences in moving VAS scores, BCS scores, rate of rescue analgesia, dosage of Tramadol, recovery time of postoperative intestinal function and the incidence of adverse reactions between the PCEA group and the CTAP group(P > 0.05),but the recovery time of lower limb motor function in CTAP group was less than that in PCEA group(P < 0.05). Conclusion Compared with PCIA and PCEA, CTAP can provide a better obstetric analgesia and less incidence of adverse reactions when used for the patients undergoing cesarean section, and the complication of CTAP is least.