腹横肌平面阻滞联合艾司氯胺酮对高龄产妇术后镇痛的影响

Effect of transversus abdominis plane block combined with intravenous esketamine on analgesia after cesarean section in elderly parturients

目的探讨腹横肌平面阻滞联合静脉注射艾司氯胺酮对高龄产妇剖宫产术后镇痛的影响。方法选择2022年8月至2023年8月在东莞市妇幼保健院接受子宫下段剖宫产的产妇72例进行随机对照试验。采用随机数字表法将入组产妇分为对照组与观察组,每组36例。对照组(40.42±9.43)岁,体质量指数(23.59±7.49)kg/cm^(2);观察组(41.91±9.32)岁,体质量指数(23.62±7.51)kg/cm^(2)。两组产妇均采用腰硬联合麻醉,术毕后实施超声引导腹横肌平面阻滞;观察组在胎儿娩出后静脉注射艾司氯胺酮0.5 mg/kg,对照组则在同一时间段静脉注射等量生理盐水。记录两组产妇术后2、4、6、12、24、48 h静息疼痛视觉模拟量表(VAS)评分;记录两组产妇首次患者自控镇痛(PCA)时间、48 h PCA总次数、氟比洛芬酯补救镇痛例数;记录两组产妇48 h下床活动次数、首次肛门排气时间;记录两组产妇眩晕、噩梦等镇痛相关不良反应发生情况。符合正态分布的计量资料两组间比较采用独立样本t检验,计数资料两组间比较采用χ^(2)检验。结果观察组术后6、12 h静息VAS评分低于对照组[(1.12±0.37)分比(1.74±0.45)分、(1.14±0.38)分比(1.78±0.47)分,均P<0.05];观察组首次PCA时间长于对照组[(9.82±1.94)h比(5.13±1.47)h,P<0.05];观察组48 h PCA总次数、氟比洛芬酯补救镇痛例数低于对照组[(7.14±1.44)次比(10.62±2.92)次、2.78%(1/36)比25.00%(9/36),均P<0.05]。观察组48 h下床活动次数多于对照组[(10.27±2.13)次比(8.14±1.68)次,P<0.05];观察组首次肛门排气时间短于对照组[(8.52±1.63)h比(12.35±2.41)h,P<0.05];观察组眩晕发生率低于对照组[5.56%(2/36)比27.78%(10/36),P<0.05]。结论腹横肌平面阻滞联合静脉注射艾司氯胺酮对高龄产妇剖宫产术后的镇痛效果显著,可降低术后VAS评分,延长首次PCA时间,减少PCA总次数,促进术后恢复。

Objective To explore the effect of transversus abdominis plane block combined with intravenous esketamine on analgesia after cesarean section in elderly parturients.Methods A total of 72 parturients who received lower uterine segment cesarean section in Dongguan Maternal and Child Health Hospital from August 2022 to August 2023 were selected for the randomized controlled trial.The included parturients were divided into a control group and an observation group by the random number table method,with 36 cases in each group.The control group were(40.42±9.43)years old;their body mass index was(23.59±7.49)kg/cm^(2).The observation group were(41.91±9.32)years old;their body mass index was(23.62±7.51)kg/cm^(2).Both groups received combined spinal-epidural anesthesia,and ultrasound-guided transversus abdominis plane block was performed in both groups after the operation.The observation group received intravenous injection of esketamine 0.5 mg/kg after the fetuses were delivered.The control group was intravenously injected the same amount of normal saline during the same period.The resting pain scores of Visual Analogue Scale(VAS)of the two groups 2,4,6,12,24,and 48 h after surgery were recorded.The first patient-controlled analgesia(PCA)times,the total numbers of PCA within 48 h,and the numbers of flurbiprofen axetil rescue analgesia cases were recorded in the two groups.The times of off-bed activities in 48 h and first anal exhaustion times in the two groups were recorded.The occurrences of analgesia-related adverse reactions,such as dizziness and nightmares,in the two groups were recorded.The measurement data of normal distribution were compared between the two group by the independent-sample t test,and the enumeration data by χ^(2) test.Results The resting pain VAS scores 6 and 12 h after surgery of the observation group were significantly lower than those of the control group[(1.12±0.37)vs.(1.74±0.45)and(1.14±0.38)vs.(1.78±0.47);both P<0.05].The first PCA time of the observation group was longer than that of the control group[(9.82±1.94)h vs.(5.13±1.47)h;P<0.05].The total number of PCA in 48 h and the number of flurbiprofen axetil rescue analgesia cases in the observation group were lower than those in the control group[(7.14±1.44)times vs.(10.62±2.92)times and 2.78%(1/36)vs.25.00%(9/36);both P<0.05].The times of off-bed activities in 48 h in the observation group was higher than that in the control group[(10.27±2.13)times vs.(8.14±1.68)times;P<0.05].The first anal exhaustion time in the observation group was shorter than that in the control group[(8.52±1.63)h vs.(12.35±2.41)h;P<0.05].The incidence of vertigo in the observation group was lower than that in the control group[5.56%(2/36)vs.27.78%(10/36);P<0.05].Conclusions Transversus abdominis plane block combined with intravenous injection of esketamine has significant analgesic effect on elderly parturients after cesarean section;it can reduce postoperative pain VAS score,prolong the first PCA time,reduce the total number of PCA,and promote postoperative recovery.