超声引导下QLB与TAPB在剖宫产术后镇痛中的应用

Application effect of ultrasound-guided quadratus lumborum block and transversus abdominis muscle block in postoperative analgesia after cesarean section

目的探讨超声引导下腰方肌阻滞(QLB)与腹横肌平面阻滞(TAPB)在剖宫产术后镇痛中的应用效果。方法选择2022年1月至2023年4月在西电集团医院行剖宫产的200例产妇作为研究对象,按照随机数表法将产妇分为观察组和对照组,每组100例。观察组产妇术后采用超声引导下QLB,对照组产妇术后采用超声引导下TAPB。比较两组产妇术后镇痛情况、术后恢复情况、术后4 h、12 h、24 h、48 h的视觉模拟评分法(VAS)评分,并比较两组产妇的不良反应发生率及对镇痛的满意度。结果观察组产妇首次按压静脉自控镇痛(PCIA)时间为(10.39±1.47)h,明显长于对照组的(7.85±1.59)h,术后24 h按压次数、舒芬太尼用量分别为(3.40±0.65)次、(41.83±5.73)μg,明显少于对照组的(5.18±0.49)次、(60.32±7.69)μg,差异均具有统计学意义(P<0.05);观察组产妇术后的排气时间、坐起时间、下床时间、泌乳时间分别为(22.82±3.69)h、(5.27±1.32)h、(25.83±3.51)h、(3.27±0.24)d,明显短于对照组的(26.74±3.41)h、(6.40±1.59)h、(28.72±3.98)h、(3.91±0.35)d,差异均具有统计学意义(P<0.05);观察组产妇术后4 h、12 h、24 h活动时VAS评分分别为(3.10±0.68)分、(3.46±0.53)分、(3.01±0.42)分,明显低于对照组的(3.62±0.73)分、(4.05±0.68)分、(3.52±0.49)分,术后4 h、12 h、24 h静息时VAS评分分别为(2.87±0.42)分、(3.18±0.39)分、(2.94±0.32)分,明显低于对照组的(3.30±0.51)分、(3.63±0.42)分、(3.31±0.45)分,差异均有统计学意义(P<0.05),但两组产妇术后48 h活动时、静息时的VAS评分比较差异均无统计学意义(P>0.05);观察组产妇的不良反应总发生率为4.00%,明显低于对照组的12.00%,观察组产妇对镇痛的总满意率为94.00%,明显高于对照组的83.00%,差异均有统计学意义(P<0.05)。结论超声引导下QLB在剖宫产术后的镇痛效果优于超声引导下TAPB,且更有助于促进产后恢复,并能降低不良反应,临床应用价值高。

Objective To explore the effect of ultrasound-guided quadratus lumborum block(QLB)and trans-versus abdominis muscle block(TAPB)in postoperative analgesia after cesarean section.Methods A total of 200 puer-peras who underwent cesarean section in Xidian Group Hospital from January 2022 to April 2023 were selected and ran-domly divided into an observation group and a control group,with 100 cases in each group.Puerperas in the observation group received postoperative ultrasound-guided QLB,while those in the control group received ultrasound-guided TAPB.The postoperative pain relief,recovery,and Visual Analogue Scale(VAS)scores at 4 h,12 h,24 h,and 48 h after surgery were compared between the two groups,and the incidence of adverse reactions and satisfaction with analgesia were also compared.Results The time for first compression of patient-controlled intravenous analgesia(PCIA)in the observation group was(10.39±1.47)h,which was significantly longer than(7.85±1.59)h in the control group.The times of compressions at 24 h after surgery and sufentanil dosage were(3.40±0.65)times and(41.83±5.73)μg,which were sig-nificantly less than(5.18±0.49)times,(60.32±7.69)μg in the control group(P<0.05).The exhaust time,sitting time,out-of-bed time,and lactation time in the observation group were(22.82±3.69)h,(5.27±1.32)h,(25.83±3.51)h,and(3.27±0.24)d,which were significantly shorter than(26.74±3.41)h,(6.40±1.59)h,(28.72±3.98)h,(3.91±0.35)d in the control group(P<0.05).The active VAS scores at 4 h,12 h,24 h after surgery in the observation group were(3.10±0.68)points,(3.46±0.53)points,and(3.01±0.42)points,which were significantly lower than(3.62±0.73)points,(4.05±0.68)points,and(3.52±0.49)points in the control group;the rest VAS scores at 4 h,12 h,24 h after surgery were(2.87±0.42)points,(3.18±0.39)points,and(2.94±0.32)points,which were significantly lower than(3.30±0.51)points,(3.63±0.42)points,and(3.31±0.45)points in the control group;the differences were statistically significant(P<0.05).There was no statisti-cally significant differences in active and rest VAS scores at 48 h after surgery between the two groups(P>0.05).The to-tal incidence of adverse reactions in the observation group was 4.00%,which was significantly lower than 12.00%in the control group,and the total satisfaction rate with analgesia in the observation group was 94.00%,which was significantly higher than 83.00%in the control group,with statistically significant differences(P<0.05).Conclusion The analgesic effect of ultrasound-guided QLB is better than that of ultrasound-guided TAPB after cesarean section.