超声引导髂腹下/髂腹股沟神经阻滞对剖宫产术后镇痛效果的影响

Effect of ultrasound-guided iliohypogastric/ilioinguinal nerve block on postoperative analgesia after cesarean section

目的研究超声引导髂腹下/髂腹股沟神经阻滞对剖宫产术后镇痛效果的影响。方法选择2019年4月—2020年3月于安徽省黄山首康医院行剖宫产分娩的80例产妇进行研究。按照随机数字表法分为对照组和试验组,各40例。对照组术后给予静脉自控镇痛,试验组在对照组基础上联合超声引导髂腹下/髂腹股沟神经阻滞镇痛。分析两组术前6 h及术后12 h视觉模拟评分(VAS),术后24 h内镇痛泵按压次数,首次排气时间,镇痛补救率,不同时间点血清泌乳素水平和初乳时间,并比较两组术后不良反应发生率。结果术后12 h,两组VAS均较术前6 h降低,且试验组VAS低于对照组,差异有统计学意义(P<0.05)。试验组术后24 h内镇痛泵按压次数少于对照组,首次排气时间短于对照组,镇痛补救率低于对照组,差异有统计学意义(P<0.05)。术后24 h,两组血清泌乳素水平均较术前1 d升高,且试验组血清泌乳素水平高于对照组,差异有统计学意义(P<0.05);试验组初乳时间短于对照组,差异有统计学意义(P<0.05)。两组术后24 h内不良反应总发生率比较,差异无统计学意义(P>0.05)。结论超声引导髂腹下/髂腹股沟神经阻滞能够有效减轻产妇术后疼痛,并可促进胃肠功能恢复和早泌乳,值得推广应用。

Objective To study the effect of ultrasound-guided iliohypogastric/ilioinguinal nerve block on postoperative analgesia after cesarean section.Methods From April 2019 to March 2020,80 pregnant women who had cesarean section in Huangshan Shoukang Hospital of Anhui Province were selected for the study.They were divided into control group and experimental group according to random number table,40 cases in each group.Control group was given patient-controlled intravenous analgesia,and experimental group was given ultrasound-guided iliohypogastric/ilioinguinal nerve block analgesia on the basis of control group.Visual analogue scale(VAS)six hours before operation and 12 hours after operation,times of pressing analgesia pump,time of first exhaust and recovery rate of analgesia,serum prolactin level at different time points and colostrum time in two groups were analyzed.The incidence of adverse reactions was compared between two groups.Results At 12 hours after operation,VAS of two groups was lower than that of six hours before operation,and VAS of experimental group was lower than that of control group,the difference was statistically significant(P<0.05).The times of pressing analgesia pump in experimental group were less than those in control group within 24 hours after operation,the first exhaust time of experimental group was shorter than that of control group,and the analgesic recovery rate of experimental group was lower than that of control group,the difference was statistically significant(P<0.05).Twenty four hours after operation,the serum prolactin levels of two groups were higher than that of one day before operation,and the serum prolactin level of experimental group was higher than that of control group,the difference was statistically significant(P<0.05).The colostrum time of experimental group was shorter than that of control group(P<0.05).There was no significant difference in the total incidence of adverse reactions between two groups within 24 hours(P>0.05).Conclusion Ultrasound-guided iliohypogastric/ilioinguinal nerve block can effectively relieve postoperative pain and promote gastrointestinal function recovery and early lactation,it is worth popularizing and applying.