后路腰方肌阻滞复合自控静脉镇痛泵用于剖宫产术后镇痛的效果观察

Effect observation of QLB block combined with PCIA for analgesia after cesarean section

目的探讨后路腰方肌阻滞(QLB)复合自控静脉镇痛泵(PCIA)用于剖宫产术后镇痛的效果。方法选取2019年1~12月我院拟行剖宫产术的足月单胎产妇80例,随机数字法分为后路组和对照组各40例,两组均行腰硬联合麻醉,后路组术毕行超声引导下双侧后路QLB(每侧注射0.5%罗哌卡因20 ml)+PCIA,对照组单纯给予PCIA。比较两组视觉疼痛模拟评分(VAS)、舒适度、镇静情况、血清泌乳素、5-羟色胺水平,记录两组首次镇痛泵按压时间、24 h内镇痛泵按压次数、镇痛药物用量、镇痛满意度及不良反应发生情况。结果后路组产妇活动状态、静息状态术后2、6、12、24 h VAS评分更低,舒适度评分更高,24 h内镇痛泵按压次数更少,产妇对镇痛满意度更高,差异均有统计学意义(P<0.05)。术后12 h,两组5-羟色胺水平均降低,两组泌乳素水平均升高,且后路组术后5-羟色胺、泌乳素水平高于对照组(P<0.05)。结论剖宫产术后行后路QLB联合PCIA镇痛满意,产妇舒适度较高。

Objective To investigate the effects of combined posterior quadratus lumborum block(QLB)with patient controlled intravenous analgesia(PCIA)for analgesia after cesarean section.Methods Eighty full-term puerperae with singleton between January 2019 and December 2019 who were scheduled to undergo cesarean section in our hospital were selected.The women were randomly divided into posterior group and control group,40 in each group.The two groups underwent combined spinal-epidural anesthesia.The posterior group underwent ultrasound-guided bilateral posterior QLB(20 ml of 0.5%ropivacaine per side)+PCIA.The control group used PCIA only.The pain,comfort,sedation and levels of serum prolactin and 5-hydroxytryptamine were compared between the two groups.The first compression time of analgesia pump,compression frequency of analgesic pump within 24 h,amount of analgesic drugs,satisfaction of analgesia and occurrence of adverse reactions were recorded in the two groups.Results Compared with the control group,VAS scores at active state and resting state in the posterior group were lower at 2,6,12 and 24 h after surgery while BCS comfort score was higher,compression frequency of analgesic pump within 24 h was lower and the analgesia satisfaction of puerperae was higher(P<0.05).After 12 h of surgery,the 5-hydroxytryptamine level was decreased while the prolactin level in the two groups was increased,and the levels of 5-hydroxytryptamine and prolactin in the posterior group were higher than those in the control group(P<0.05).Conclusion After cesarean section,QLB combined with PCIA have satisfactory analgesia effects and high maternal comfort.