多模式镇痛方案下超声引导腰方肌阻滞与腹横肌平面阻滞对剖宫产产妇血压及胎儿内环境的影响

Effects of ultrasound-guided quadratus lumbosum block or transversus abdominis plane block under multimodal analgesia regimen during cesarean section on blood pressure and fetal internal environment

目的:分析多模式镇痛方案引导下超声引导腰方肌阻滞与腹横肌平面阻滞对剖宫产产妇血压及胎儿内环境的影响。方法:选择2019年6月-2021年6月我院收治的拟行剖宫产术者106例,随机数字表法分为对照组(n=52)和观察组(n=54),分别采用多模式镇痛方案下超声引导的腹横肌平面阻滞或多模式镇痛方案下超声引导的腰方肌阻滞治疗。使用视觉模拟评分法(VAS)、Ramsay镇静评分法评估产妇麻醉前(T1)、麻醉和阻滞后10 min(T2)、术后即刻(T3)、术后4h(T4)、术后12h(T5)止痛效果、镇静程度,比较两组上述时点血压变化,通过血气分析、Apgar评分比较两组胎儿内环境变化。结果:麻醉和阻滞后及术后各时点观察组VAS评分均较对照组降低,存在时间、分组及交互效应,观察组T2~T4 VAS评分均较对照组降低(均P<0.05)。两组组内不同时点Ramsay镇静评分有差异(P<0.05),但组间各时点评分无差异(P>0.05)。平均血压两组组内不同时点有差(P<0.05),但组间各时点无差异。胎儿脐动脉血气氧分压、二氧化碳分压、乳酸值和Agar评分均无差异(P>0.05)。结论:多模式镇痛方案引导下超声引导腰方肌阻滞比腹横肌平面阻滞效果止痛镇静效果更好,两种阻滞方法对产妇生命体征和胎儿内环境的稳定无明显影响。

Objective:To analyze the effects of ultrasound-guided quadratus lumborum block or transverse abdominis plane block under the guidance of multimodal analgesia regimen during cesarean section of pregnant women on their blood pressure and fetal internal environment of undergoing.Methods:106 pregnant women who wanted cesarean section were selected and were divided into control group(n=52)and observation group(n=54)according to the random number table method between June 2019 and June 2021.The women in the control group were treated with ultrasound-guided transversus abdominis plane block under multimodal analgesia regimen,and the women in the observation group were given ultrasound-guided quadratus lumbosum block under multimodal analgesia regimen.The analgesic effect evaluated by Visual Analogue Scale(VAS)or the sedation degree evaluated by Ramsay sedation scoring method of the women before anesthesia(T1),after 10 min of anesthesia and block(T2),immediately after surgery(T3),and at 4 h after surgery(T4)and at 12 h after surgery(T5)was conducted.The blood pressure changes of the women at T1,T2,T3,T4,and T5 were compared between the two groups.The changes of fetal internal environment evaluated by blood gas analysis and Apgar score of the newborns were compared between the two groups.Results:The VAS score of the women in the observation group after anesthesia and block,at T3,T4,and T5 was significantly lower than that of the women in the control group,which had interaction effects between time and grouping.The VAS score of the women in the observation group at T2-T4 was significantly lower than that of the women in the control group(all P<0.05).There were significant differences in Ramsay sedation scores of the women in the two groups among different time points(P<0.05),but there were no significant differences in Ramsay sedation scores of the women at different time points between the two groups(P>0.05).There was significant difference in the mean blood pressure value of the women at different time points between the two groups(P<0.05),but there was no significant difference in the mean blood pressure value of the women in the two groups among different time points.There were no significant differences in the values of blood gas oxygen partial pressure,carbon dioxide partial pressure,and lactate value in fetal umbilical artery blood,and the Agar scores of the newborns between the two groups(P>0.05).Conclusion:The analgesic and sedative effects of the pregnant women of ultrasound-guided quadratus lumborum block under the guidance of multimodal analgesia regimen during cesarean section are better than those of ultrasound-guided transverse abdominis plane block,and both of which have no significantly effect on the maternal vital signs and the stability of fetal internal environment.