超声引导下腹横肌平面阻滞在全麻剖宫产术后镇痛应用

Application of ultrasound guided transverse abdominal plane block for analgesia of women after cesarean section under general anesthesia

目的:探讨超声引导下腹横肌平面阻滞在全麻剖宫产术后镇痛中的应用。方法:选择2014年6月-2017年8月本院收治的全麻下行剖宫产手术孕妇102例,根据术后镇痛方法分为两组各51例,对照组术后给予静脉自控镇痛(PCIA),观察组在对照组基础上给予超声引导下腹横肌平面阻滞(TAPB)。对比两组术后泌乳素水平、疼痛视觉模拟评分(VAS)、镇痛药用量及镇痛泵按压次数、并发症、产妇镇痛满意度等。结果:两组术后6h、12h、24h、48h血清泌乳素水平呈升高趋势,且观察组各时点水平均高于对照组(均P<0.05);观察组术后0~12h、12~24h镇痛泵药物用量及按压次数均低于对照组(P<0.05);两组术后3h、6h、12h、24h时VAS评分均呈不断降低趋势,且观察组各时点评分均低于对照组,术后不良反应发生率低于对照组,镇痛满意度高于对照组(均P<0.05)。结论:超声引导下TAPB应用于全麻剖宫产术后镇痛,可明显降低镇痛药物用量及镇痛泵按压次数,减轻产妇术后疼痛,促进产后泌乳,不良反应发生率低及产妇满意度高。

Objective:To investigate the application of ultrasound guided transverse abdominal plane block for analgesia of women after cesarean section under general anesthesia.Methods:102 women who underwent cesarean section under general anesthesia from June 2014 to August 2017 were selected as the research subjects and divided into two groups according to the different postoperative analgesia methods(51 cases in each group).The women in control group were given patient control intravenous analgesia(PCIA)after operation,and the women in study group had received ultrasound guided transversus abdominis plane block(TAPB)combined with PCIA.The postoperative prolactin levels,postoperative visual analogue scale(VAS),the dosage of analgesics,the press times of the analgesic pump,the incidence of postoperative complications,and the satisfaction of parturients were compared between the two groups.Results:The serum prolactin level of women in both groups at 6h and 12h,24h or 48h after operation had increased(P<0.05),and the serum prolactin level of women in the study group was significant higher than that of women in the control group at 6h and 12h,24h or 48h after operation(P<0.05).The analgesia drug dosage and the press times of analgesia pump of women in the study group during the postoperative 012h and postoperative 1224h were significant lower than those of women in the control group(P<0.05).The VAS of women in both groups at 3h,6h,12h and 24h after operation had gradually reduce(P<0.05),and the VAS of women in the study group at 3h,6h,12h or 24h after operation was significant lower than that of women in the control group(P<0.05).The incidence rate of adverse reactions of women in the study group was significant lower than that of women in the control group(P<0.05).The satisfaction on analgesia of women in the study group was significant higher than that of women in the control group(P<0.05).Conclusion:Ultrasound guided TAPB was used for analgesia of women after cesarean section can obviously reduce the dosage of analgesic drugs and the press times of the analgesic pump,alleviate the postoperative pain,promote the postpartum lactation,and improve the satisfaction degree of womenn with less adverse reaction.