快速康复理念下腰硬联合麻醉联合PIEB与CEI在剖宫产术后镇痛的应用效果分析

Analysis of the application effect of lumbar anesthesia combined with PIEB and CEI in postoperative analgesia after cesarean section under the enhanced recovery after surgery

目的探究快速康复理念下腰硬联合麻醉联合程控硬膜外间歇脉冲注入(PIEB)与连续硬膜外输注(CEI)在剖宫产术后镇痛的应用效果分析。方法选取2022年5月至2023年5月汕头市第二人民医院麻醉科纳入的择期剖宫产手术的孕妇160例,按照随机数表法分为观察组和对照组,每组各80例。对照组采用传统麻醉用药方案,观察组采用优化麻醉用药方案。评估两组孕妇术中药物追加情况、手术时间、尿管拔出时间、下床活动时间、术中并发症、术后镇痛效果。结果观察组孕妇术中硬膜外药物追加例数、手术时间与对照组比较,差异无统计学意义(P>0.05);观察组孕妇术后尿管拔出时间、下床活动时间均明显短于对照组,差异有统计学意义(P<0.05);观察组孕妇术中低血压、恶心呕吐、寒战发生率均低于对照组,差异有统计学意义(P<0.05);术后6 h,观察组与对照组孕妇视觉模拟评分法(VAS)评分比较,差异无统计学意义(P>0.05),术后12及24 h,观察组孕妇VAS评分均明显低于对照组,差异有统计学意义(P<0.05)。结论快速康复理念下腰硬联合麻醉联合PIEB与CEI应用于剖宫产孕妇,可有效降低术中并发症的发生,缩短术后尿管拔出时间以及下床活动时间,提高术后镇痛效果。

Objective To explore the application effect of lumbar anesthesia combined with programmed intermittent epidural boluses(PIEB)and continuous epidural infusion(CEI)in postoperative analgesia after cesarean section under enhanced recovery after surgery.Methods A total of 160 pregnant women who underwent elective cesarean section in the Anesthesiology Department of the Second People’s Hospital of Shantou from May 2022 to May 2023 were selected and divided into an observation group and a control group using a random number table method,with 80 cases in each group.The control group adopted a traditional anesthesia medication regimen,while the observation group adopted an optimized anesthesia medication regimen.The intraoperative medication supplementation,surgical time,catheter withdrawal time,off-bed activity time,intraoperative complications,and postoperative analgesic effect of the two groups of pregnant women were evaluated.Results There was no significant difference in the number of additional epidural medication cases and surgical time between the observation group and the control group,without statistically significant differences(P>0.05).The observation group had significantly shorter postoperative catheter withdrawal time and off-bed activity time compared to the control group,with statistically significant differences(P<0.05).The incidence of intraoperative hypotension,nausea,vomiting,and chills in the observation group was lower than that in the control group,with statistically significant difference(P<0.05).At 6 hours after surgery,there were no significant differences in the visual analogue scale(VAS)scores between the observation group and the control group,without statistically significant difference(P>0.05).At 12 hours and 24 hours after surgery,the VAS scores of the observation group were significantly lower than those of the control group,with statistically significant difference(P<0.05).Conclusion The application of lumbar anesthesia combined with PIEB and CEI under the enhanced recovery after surgery in pregnant women undergoing cesarean section can effectively reduce the occurrence of intraoperative complications,shorten the time for postoperative catheter withdrawal and off-bed activity,and improve the postoperative analgesic effect.