超声引导下神经阻滞多模式镇痛对剖宫产术后镇痛效果及血清儿茶酚胺和泌乳素的影响

Effect of ultrasound guided multimodal analgesia with nerve block on analgesia after cesarean section and serum catecholamine and prolactin

目的探讨超声引导下神经阻滞多模式镇痛对剖宫产术后镇痛效果及血清儿茶酚胺(catecholamine,CA)和泌乳素(prolactin,PRL)水平的影响。方法选取2019年1月至2022年6月江阴市中医院收治的120例分娩产妇,采用随机数字表法分为对照组和观察组,每组60例。两组均行蛛网膜下腔麻醉,并采用超声引导下神经阻滞多模式镇痛,观察组行双侧腰方肌阻滞,对照组行双侧腹横肌平面阻滞。比较两组术后不同时点(4 h、12 h和24 h)静息状态和运动状态的疼痛数字评分量表(numerical rating scale,NRS)变化、术后临床指标、手术前后血流动力学指标(MAP、HR)变化及CA[多巴胺(dopamine,DA)、去甲肾上腺素(norepinephrine,NE)、肾上腺素(epinephrine,E)]和PRL水平,观察两组不良反应发生率。结果两组术后4 h和12 h静息状态NRS评分比较,差异无统计学意义(P>0.05),观察组术后24 h静息状态NRS评分低于对照组[(1.02±0.19)分比(1.38±0.22)分],差异有统计学意义(P<0.05);两组术后4 h运动状态NRS评分比较,差异无统计学意义(P>0.05),观察组术后12 h、24 h运动状态NRS评分低于对照组[(1.56±0.24)分比(1.81±0.31)分,(1.05±0.15)分比(1.43±0.21)分],差异均有统计学意义(P<0.05)。两组术后首次肛门排气时间、术后首次进食时间、术后首次站立时间比较,差异均无统计学意义(P>0.05);观察组术后镇痛泵首次使用时间晚于对照组[(25.13±1.61)h比(12.14±1.11)h],术后24 h内镇痛泵按压次数少于对照组[(4.35±1.58)次比(7.63±2.44)次],术后首次下床时间和初乳时间早于对照组[(5.32±1.25)h比(6.98±2.55)h,(21.62±5.43)h比(30.84±4.34)h],差异均有统计学意义(P<0.05)。两组术后DA、NE、E、PRL水平及MAP、HR较术前升高,且观察组术后DA、NE、E及MAP、HR低于对照组[(121.51±14.75)ng/L比(159.63±14.63)ng/L、(642.22±56.47)ng/L比(732.44±55.81)ng/L、(71.33±10.15)ng/L比(89.75±11.63)ng/L、(81.32±9.06)mmHg比(89.74±10.43)mmHg(1 mmHg=0.133 kPa)、(80.16±9.51)次/min比(88.97±10.39)次/min],PRL水平高于对照组[(348.93±39.44)μg/L比(232.38±35.98)μg/L],差异均有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论超声引导下双侧腰方肌阻滞用于剖宫产术后多模式镇痛的效果显著优于超声引导下腹横肌平面阻滞,可减少术后镇痛泵使用次数,促进产妇恢复,抑制CA释放,进而改善疼痛对PRL分泌的影响,且安全性高。

Objective To investigate the effects of ultrasound guided multimodal analgesia with nerve block on the analgesic effect and serum catecholamine(CA)and prolactin(PRL)levels after cesarean section.Methods From January2019 to June 2022,120 parturients in Jiangyin Hospital of Traditional Chinese Medicine were selected and divided into control group and observation group by random number table method,with 60 cases in each group.Both groups received subarachnoid anesthesia and ultrasound guided nerve block multi-mode analgesia.The observation group received bilateral lumbar quadratus block,and the control group received bilateral transverse abdominal muscle plane block.The changes of the pain numerical rating scale(NRS)of the resting state and motor state of the two groups at different time points(4 h,12 h and24 h)after surgery,postoperative clinical indicators,changes in hemodynamic parameters(MAP,HR),and CA[dopamine(DA),norepinephrine(NE),epinephrine(E)]and PRL levels were compared,and the incidence of adverse reactions in the two groups was observed.Results As for the NRS score of the resting state,there was no significant difference between the two groups at 4 h and 12 h after surgery(P>0.05),and the score at 24 h after surgery in the observation group was lower than that in the control group[(1.02±0.19)points vs.(1.38±0.22)points],the difference was statistically significant(P<0.05).As for the NRS score of the motor state,there was no significant difference in NRS score between the two groups at 4 h after operation(P>0.05),and the NRS scores at 12 h and 24 h after operation in the observation group were lower than those in the control group[(1.56±0.24)points vs.(1.81±0.31)points,(1.05±0.15)points vs.(1.43±0.21)points],the difference were statistically significant(P<0.05).There was no significant difference in the time of the first anal exhaust,the time of the first eating and the time of the first standing between the two groups(P>0.05).The first time of the analgesia pump use in the observation group was later than that in the control group[(25.13±1.61)h vs.(12.14±1.11)h],the number of press times of the analgesia pump within 24 h after operation was less than that in the control group[(4.35±1.58)times vs.(7.63±2.44)times],and the first time of getting out of bed and colostrum time after operation were earlier than those in the control group[(5.32±1.25)h vs.(6.98±2.55)h,(21.62±5.43)h vs.(30.84±4.34)h],with statistically significant differences(P<0.05).The levels of DA,NE,E,PRL,MAP and HR in the two groups after operation were higher than those before operation,the DA,NE,E,MAP and HR in the observation group were lower than those in the control group[(121.51±14.75)ng/L vs.(159.63±14.63)ng/L,(642.22±56.47)ng/L vs.(732.44±55.81)ng/L,(71.33±10.15)ng/L vs.(89.75±11.63)ng/L,(81.32±9.06)mmHg vs.(89.74±10.43)mmHg(1 mm Hg=0.133 kPa),(80.16±9.51)times/min vs.(88.97±10.39)times/min],and the PRL was higher than that in the control group[(348.93±39.44)μg/L vs.(232.38±35.98)μg/L],the differences were statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions The effect of ultrasound guided bilateral lumbar quadratus block on multi-mode analgesia after cesarean section is significantly better than ultrasound guided abdominal transverse muscle plane block,which can reduce the number of postoperative analgesia pump use,promote maternal recovery,inhibit CA release,and then improve the impact of pain on PRL secretion,with high safety.