超声引导下腰方肌阻滞对剖宫产产妇泌乳素水平的影响

Effect of ultrasound-guided quadratus lumborum block on prolactin levels in puerperants with cesarean section

目的观察超声引导下腰方肌阻滞对剖宫产后产妇泌乳素水平的影响。方法选取湖州市南浔区人民医院2019年7月至2020年7月收治的剖宫产产妇120例,按随机数字表法分为观察组和对照组,每组60例。观察组术后给予超声引导腰方肌阻滞+静脉自控镇痛(PCIA),在超声引导下行后路腰方肌阻滞,双侧各注射0.375%罗哌卡因20 ml;对照组术后仅给予静脉自控镇痛。观察两组产妇术后6、12、24和48 h等时点视觉模拟评分法(VAS)评分(静息和运动)和Ramsay镇静评分,并于上述各时点抽取静脉血检测血清多巴胺、去甲肾上腺素、肾上腺素和泌乳素水平,记录两组患者不良反应发生情况、PCIA按压次数、追加吗啡用量和初乳时间。结果观察组产妇术后不同时点静息和运动VAS评分均低于对照组,Ramsay镇静评分高于对照组(均P<0.05),观察组产妇PCIA按压次数、追加吗啡用量和不良反应发生率均低于对照组(均P<0.05)。观察组产妇血清多巴胺、去甲肾上腺素、肾上腺素均低于对照组(均P<0.05),观察组产妇血清泌乳素水平高于对照组(P<0.05),观察组产妇初乳时间早于对照组(P<0.05)。结论超声引导下腰方肌阻滞可以有效减轻产妇剖宫产术后疼痛,减少不良反应,促进泌乳素分泌,缩短初乳时间。

Objective To investigate the effect of quadratus lumborum block on the serum prolactin levels of puerperants with cesarean section.Methods One hundred and twenty pregnant women undergoing cesarean section in Huzhou Nanxun District People's Hospital from July 2019 to July 2020 were randomly assigned in two groups with 60 cases in each group:puerperants in study group received ultrasound-guided lumbar quadratus block(20 ml of 0.375%ropivacaine in both sides)for cesarean section and patient-controlled intravenous analgesia(PCIA)after operation,while puerperants in control group received postoperative PCIA only.The visual analogue scale(VAS)and Ramsay sedation scale at 6 h,12 h,24 h and 48 h after the surgery were assessed and compared between two groups.The vein blood were sampled for measuring dopamine,norepinephrine,epinephrine and prolactin.The times of PCIA pressing,the addition of observe.Results The VAS scores of study group were lower than those in control group in all time points(P<0.05),while the Ramsay sedation scores of study group were higher than those in control group(P<0.05).The adverse reaction,the times of PCIA pressing and the addition of morphine in study group were lower than those in control group(P<0.05).The serum dopamine,norepinephrine and epinephrine levels of study group were lower than those of control group(P<0.05),while the serum prolactin level of study group was higher than that of control group(P<0.05).The colostrum time in the study group was significantly earlier than that in the control group(P<0.05).Conclusion Ultrasound guided-quadratus lumborum block can effectively alleviate the pain after cesarean section,reduce adverse reactions,promote prolactin secretion and shorten colostrum time.