超声引导下腰方肌筋膜平面阻滞复合右美托咪定在剖宫产术后镇痛的应用效果观察

Effect of ultrasound-guided lower back quadrate fascia block combined with dexmedetomidine in analgesia after cesarean section

目的研究超声引导下腰方肌筋膜平面阻滞复合右美托咪定在剖宫产术后镇痛的应用效果。方法研究对象选取2021年1月到2024年1月桐城市人民医院行剖宫产产妇98例,使用随机数字表法将所有产妇分为对照组及观察组各49例。两组产妇均行常规剖宫产手术,对照组术后行双侧腰方肌筋膜平面阻滞,观察组行双侧腰方肌筋膜平面阻滞复合右美托咪定。比较两组产妇术后恢复情况、疼痛评分、舒芬太尼用量、睡眠质量及不良反应发生率。结果两组年龄、孕周、体质指数(body mass index,BMI)等基线资料差异无统计学意义(P>0.05)。观察组术后首次站立时间为(5.52±1.09)h、下床行走时间为(7.45±1.79)h、初乳时间为(27.61±2.92)h,对照组这三个指标分别为(6.94±1.48)h、下床行走时间(9.52±2.03)h、初乳时间(32.08±3.45)h,观察组低于对照组(P<0.05)。观察组术后12 h、24 h静息数字评价量表(numerical rating scale,NRS)评分为2.58±0.53、1.57±0.68,对照组术后12 h、24 h静息NRS评分为3.54±0.75、3.12±1.01,观察组低于对照组(P<0.05)。观察组术后12 h、24 h活动NRS评分为3.61±0.72、3.01±0.99,对照组12 h、24 h活动NRS评分为4.12±0.79、3.73±1.08,观察组低于对照组(P<0.05)。观察组12 h、24 h、48 h舒芬太尼用量为(15.17±3.24)μg、(23.28±4.02)μg、(41.61±4.82)μg,48 h镇痛泵按压次数为(2.94±1.22)次,补救镇痛例数3次;对照组12 h、24 h、48 h舒芬太尼用量为(20.08±4.03)μg、(36.14±4.57)μg、(59.33±6.25)μg,48 h镇痛泵按压次数为(6.15±1.71)次,补救镇痛例数10次,观察组低于对照组(P<0.05)。观察组术后1 d、2 d、3 d PSQI评分为13.25±1.08、15.28±1.16、16.45±1.25,对照组术后1 d、2 d、3 d PSQI评分为15.14±1.15、16.31±1.21、17.34±1.31,观察组低于对照组(P<0.05)。观察组不良反应发生率为10.20%,对照组不良反应发生率为26.53%,观察组低于对照组(P<0.05)。结论超声引导下腰方肌筋膜平面阻滞复合右美托咪定有助于提高剖宫产产妇术后恢复,降低产妇术后疼痛及舒芬太尼用量,改善产妇睡眠质量、减少不良反应,具有较好镇痛效果。

Objective To study the efficacy of ultrasound-guided lower back quadrate fascia plane block combined with dexmedetomidine in postoperative analgesia after cesarean section.Methods 98 cases of women who underwent cesarean section in our hospital from Jan.2021 to Jan.2024 were selected,and all patients were divided into control group and study group with 49 cases each using random number table method.Both groups received routine cesarean section,the control group was given quadrate fascia plane block,and the study group was given quadrate fascia plane block combined with dexmedetomidine.The postoperative recovery,pain score,sufentanil dosage,sleep quality and incidence of adverse reactions were compared between the two groups.Results There was no significant difference in age,gestational age or BMI between the two groups(P>0.05).The first standing time of the study group was(5.52±1.09)h,the walking time of getting out of bed was(7.45±1.79)h,and the colostrum time was(27.61±2.92)h.The three indexes of the control group were(6.94±1.48)h,the walking time of getting out of bed was(9.52±2.03)h,and the colostrum time was(32.08±3.45)h,respectively.The study group was lower than the control group(P<0.05).The NRS score at rest 12h and 24h after surgery was(2.58±0.53;1.57±0.68)score,12h,24h resting NRS score of control group was 3.54±0.75,3.12±1.01;The score was lower in the study group than that in the control group(P<0.05).The NRS scores of 12h and 24h postoperative activities in the study group were(3.61±0.72;The NRS score of 12h and 24h activities in the control group was 4.12±0.79,3.73±1.08;The score in the study group was lower than that in the control group(P<0.05).The dosage of sufentanil for 12h,24h and 48h in the study group was(15.17±3.24;23.28±4.02;41.61±4.82)μg,48h analgesic pump compression times were(2.94±1.22)times,the number of relief analgesia cases were 3 times,the dosage of sufentanil at 12h,24h,48h in the control group was(20.08±4.03;36.14±4.57;59.33±6.25)μg,48h analgesic pump compression times were(6.15±1.71)times,the number of relief analgesia cases was 10 times,the study group was lower than the control group(P<0.05).The PSQI scores at 1d,2d and 3d were 15.14±1.15;16.31±1.21;17.34±1.31 in the control group,while they were 13.25±1.08;15.28±1.16;16.45±1.25 in the study group,lower than that in the control group(P<0.05).The incidence of adverse reactions was 10.20%in the study group and 26.53%in the control group,lower than that in the control group(P<0.05).Conclusion Ultrasound-guided lower back quadrate fascia plane block combined with dexmedetomidine can improve the recovery after cesarean section,reduce the pain after delivery and sufentanil dosage,improve the quality of sleep and reduce adverse reactions,and have a good analgesic effect.