超声引导下腰方肌阻滞联合应用纳布啡对剖宫产术后镇痛的效果

Effectiveness of ultrasound-guided quadratus lumborum block combined with naborphine in postoperative analgesia after cesarean section

目的探讨超声引导下腰方肌阻滞联用纳布啡在剖宫产术后镇痛中的效果。方法选取2021年4月至2022年4月在深圳市宝安区妇幼保健院产科接受剖宫产术的初产妇为研究对象,基于随机数字表法分成研究组与对照组。对照组术后行纳布啡静脉自控镇痛(patient-controlled intravenous analgesia,PCIA),研究组行超声引导下腰方肌阻滞联用纳布啡。观察两组术前及术后4 h、8 h、12 h、24 h的血压、心率,并应用视觉模拟评分(visual analogue scale,VAS)评估术后4 h、8 h、12 h、24 h切口疼痛度,应用Ramsay镇静评分评估术后镇静状态,了解镇痛泵应用情况。结果共纳入110例产妇,研究组和对照组各55例。与对照组相比,研究组术后4 h、8 h、12 h、24 h的心率、平均动脉压、VAS评分均显著降低(P<0.05),术后1 h、6 h Ramsay镇静评分升高(P<0.05)。研究组首次按压镇痛泵时间大于对照组,术后24 h内镇痛泵有效按压次数小于对照组(P<0.05)。结论在剖宫产术后镇痛中采取超声引导下腰方肌阻滞联用纳布啡,可有效减轻术后疼痛,且术后镇静效果良好。

Objective To investigate the effects of ultrasound-guided quadratus lumborum block combined with nalbuphine in analgesia after caesarean section.Methods Primiparas who underwent cesarean section in the department of obstetrics at Shenzhen Baoan Maternal and Child Healthcare Hospital from April 2021 to April 2022 were selected as the research subjects,and were divided into a study group and a control group based on random number table method.The control group underwent nalbuphine venous patient-controlled intravenous analgesia(PCIA)after surgery,and the study group underwent ultrasound-guided quadratus lumborum block combined nalbuphine.The mean arterial pressure(MAP)and heart rate(HR)of the two groups were observed before surgery and at 4 h,8 h,12 h and 24 h after surgery,visual analogue score(VAS)was used to evaluate the pain of incision at 4 h,8 h,12 h and 24 h after surgery,and the Ramsay sedation score was used to evaluate the postoperative sedation status and understand the application of analgesic pumps.Results A total of 110 participants were enrolled,with 55 cases each in the study group and the control group.Compared with the control group,the HR,MAP and VAS scores of 4 h,8 h,12 h,and 24 h after surgery were significantly reduced(P<0.05),and the Ramsay scores of sedation 1 h and 6 h after surgery were increased(P<0.05).The first compression time of the analgesia pump in the study group was greater than that of the control group,and the effective compression of the analgesia pump within 24 hours after surgery was less than that of the control group(P<0.05).Conclusion Ultrasound-guided quadratus lumborum block combined with nalbuphine in post-cesarean analgesia can effectively reduce postoperative pain,and has a good postoperative sedation effect.