超声引导下双侧TAP阻滞在剖宫产术后镇痛中的应用

Application of Ultrasound-guided Bilateral TAP Block in Postoperative Analgesia after Cesarean Section

目的:探究超声引导下双侧腹横肌平面(TAP)阻滞在腰硬联合麻醉剖宫产术后镇痛中的应用效果。方法:采用前瞻性研究,选取2018年5月~2020年5月行剖宫产手术产妇200例为研究对象,采用奇偶数分组法分组,奇数号100例为对照组,偶数号100例为观察组。两组产妇均给予腰硬联合麻醉,术后对照组给予静脉自控镇痛,观察组给予静脉自控镇痛联合超声引导下双侧TAP阻滞。对两组产妇术后疼痛程度、舒适度、血清因子水平、镇痛泵按压次数、并发症及不良反应发生情况进行比较。结果:观察组产妇各时间点VAS疼痛评分均显著低于对照组,舒适度量表评分均显著高于对照组(P<0.05);术后24 h,两组产妇血糖、皮质醇、白介素-6水平均高于术前,但观察组显著低于对照组(P<0.05);术后72 h内,观察组产妇镇痛泵按压次数、不良反应发生率均低于对照组(P<0.05)。结论:腰硬联合麻醉剖宫产术后采用静脉自控镇痛联合超声引导下双侧腹横肌平面阻滞镇痛效果良好,安全性较高。

Objective:To explore the effect of ultrasound-guided bilateral transverse abdominal muscle plane(TAP)block in analgesia after cesarean section under combined spinal epidural anesthesia.Methods:This study was a prospective study,and a total of 200 women who underwent cesarean section from May 2018 to May 2020 were selected as the study subjects.The odd and even grouping method was adopted,with 100 cases of odd number as the control group and 100 cases of even number as the observation group.Both groups were given combined spinal epidural anesthesia.After surgory the control group was given patient-controlled intravenous analgesia,and the observation group was given patient-controlled intravenous analgesia combined with ultrasound-guided bilateral TAP block.The postoperative pain degree,comfort level,serum factors,pressure times of analgesic pump,incidence of complications and adverse reactions were compared between the two groups.Results:VAS pain score in the observation group was significantly lower than that in the control group at each time point and Bruggrmann comfort scale(BCS)score was significantly higher than that of control group(P<0.05);24 h after operation,the levels of blood glucose,cortisol and IL-6 in two groups were higher than those before operation,but the observation group was significantly lower than the control group(P<0.05);within 72 h after operation,pressure times of analgesic pump and the incidence of adverse reactions in the observation group were lower than those in the control group(P<0.05).Conclusion:Patient-controlled intravenous analgesia combined with ultrasound-guided bilateral TAP block after cesarean section under combined spinal epidural anesthesia has good analgesic effect and high safety.