超声引导下腰方肌阻滞联合硬膜外自控镇痛对剖宫产产妇术后疼痛及下肢运动功能的影响

Effect of ultrasound-guided quadratus lumborum block combined with patient-controlled epidural analgesia on postoperative pain and lower extremities motor function in puerperae undergoing cesarean section

目的探讨超声引导下腰方肌阻滞联合硬膜外自控镇痛(PCEA)对剖宫产产妇术后疼痛及下肢运动功能的影响。方法将拟行剖宫产术的100例初产妇,随机分为腰方肌阻滞联合PCEA组(Q组)和PCEA组(P组),各50例。术后两组产妇均使用PCEA,Q组产妇同时行超声引导下双侧腰方肌阻滞。术后2 h、4 h、6 h、12 h、24 h、48 h,采用Bromage评分和数字评价量表(NRS)分别对产妇下肢运动功能和疼痛程度进行评价。记录两组产妇首次下床时间、首次行走时间、PCEA泵按压次数、术后恶心呕吐(PONV)及尿潴留的发生情况。结果Q组术后2 h、4 h、6 h静止时和咳嗽时NRS评分均低于P组(均P<0.05),但在其余时点差异无统计学意义(均P>0.05)。Q组术后PCEA按压次数少于P组,尿潴留发生率低于P组(均P<0.05)。两组产妇术后各时点Bromage评分、术后首次下床时间、首次行走时间差异均无统计学意义(均P>0.05)。结论与单纯PCEA比较,超声引导下腰方肌阻滞联合PCEA能更有效地控制剖宫产产妇术后早期疼痛,降低尿潴留发生率,但对产妇下肢运动功能的影响尚不明确。

Objective To explore the effect of ultrasound-guided quadratus lumborum block combined with patient-controlled epidural analgesia(PCEA)on postoperative pain and lower extremities motor function in the puerperae undergoing cesarean section.Methods A hundred puerperae scheduled for cesarean section were randomized into quadratus lumborum block combined with PCEA group(group Q)and PCEA group(group P),with 50 cases in each group.After operation,the puerperae of both groups received PCEA,and the puerperae of group Q also underwent ultrasound-guided bilateral quadratus lumborum block.After 2 h,4 h,6 h,12 h,24 h and 48 h of operation,Bromage score and numerical rating scale(NRS)were applied to assess the motor function of lower extremities and pain severity,respectively.Relevant indicators of the puerperae in both groups were recorded,including the durations for the first ambulation and walking,frequency of pressing PCEA pump,incidence of postoperative nausea and vomiting(PONV)and uroschesis.Results The NRS scores at rest and when coughed were lower in the group Q than those in group P at 2 h,4 h and 6 h of operation(all P<0.05),whereas no significant difference in the NRS score between the two groups were found at the other time points(all P>0.05).Group Q obtained less frequency of pressing PCEA pump and lower incidence rate of uroschesis compared with group P(P<0.05).There were no significant differences between the two groups in the Bromage score at each time point,and the duration for the first postoperative ambulation and walking(all P>0.05).Conclusion Compared with PCEA alone,ultrasound-guided quadratus lumborum block combined with PCEA can more effectively control early postoperative pain and reduce the incidence rate of uroschesis in the puerperae undergoing cesarean section;however,its effect on lower extremities motor function of puerperae is not confirmed yet.