腹横筋膜平面阻滞联合剖宫产术后静脉自控镇痛对产妇泌乳功能及性功能的影响

Effects of transverse abdominis plane block combined with patient controlled intravenous analgesia after cesarean section on lactation function and sexual function of puerperae

目的探究腹横筋膜平面(TAP)阻滞联合剖宫产术后静脉自控镇痛(PCIA)对产妇泌乳功能及性功能的影响。方法选取2018年8月至2020年12月于义乌市中心医院行剖宫产手术的125例产妇作为研究对象。按照随机数字表法分成观察组(n=62)和对照组(n=63),对照组采用PCIA,观察组采用TAP阻滞联合PCIA。比较两组产妇术后不同时间的视觉模拟评分法(VAS)评分,比较两组产妇镇痛泵按压次数、初乳时间、不同时间的催乳素水平及性功能评分。结果观察组产妇术后不同时间的VAS评分均低于对照组,观察组镇痛泵按压次数少于对照组(P<0.05);观察组产妇的初乳时间较对照组短(P<0.05);两组产妇术后24h、48h的催乳素水平均高于术前30min,且观察组的催乳素水平高于对照组(P<0.05);两组产妇的性功能评分及不良反应发生率比较,差异无统计学意义(P>0.05)。结论TAP阻滞联合PCIA对行剖宫产产妇的术后镇痛效果优于单一PCIA,且能有效改善产妇术后泌乳情况,对性功能不会造成不良影响,具有一定安全性。

Objective To explore the effects of transverse abdominis plane(TAP)block combined with patient controlled intravenous analgesia(PCIA)after cesarean section on lactation function and prognostic sexual function of puerperae.Methods A total of 125 puerperae undergoing cesarean section in Yiwu Central Hospital were enrolled between August 2018 and December 2020.They were divided into observation group(n=62)and control group(n=63)according to random number table method.The control group was given PCIA,while observation group was given TAP block combined with PCIA for postoperative analgesia.Visual analogue scale(VAS)score was compared between the two groups after surgery.The pressing times of analgesia pump,colostrum time,the prolactin level at different time points,and score of prognostic sexual function between the two groups were compared.Results VAS score of the observation group was lower than that of the control group at different time after operation,and the pressing times of analgesic pump in the observation group was fewer than those in the control group(P<0.05).The colostrum time in the observation group was shorter than that in the control group(P<0.05).The level of prolactin at 24 h and 48 h after operation was higher than that at 30 min before operation in both groups,and the level of prolactin in observation group was higher than that in control group(P<0.05).There was no significant difference in the scores of maternal sexual function and incidence of adverse reactions between the two groups(P>0.05).Conclusions The postoperative analgesia effect of TAP block combined with PCIA is better than that of PCIA alone in cesarean section,which can effectively improve postoperative lactation,without adverse effects,and has a certain safety.