超声引导下的腰方肌阻滞与腹横筋膜阻滞对剖宫产产妇的安全性和有效性

Comparison of safety and efficacy in parturients with cesarean section between ultrasound-guided quadratus lumborum block and transverse abdominis plane block

目的研究超声引导下腰方肌阻滞(QLB)或腹横筋膜阻滞(TAPB)在剖宫产术中的安全性及有效性。方法剖宫产术的产妇82例,随机均分为对照组和观察组,两组均实施持续硬膜外麻醉,在超声引导下对照组使用TAPB、观察组使用QLB,两组术后使用罗哌卡因及自控静脉镇痛(PCIA),对比两组产妇首次按压镇痛泵时间,24 h内按压有效次数、镇痛补救率、术后恢复指标;观察两组产妇术后4、8、12、24、48 h视觉模拟评分表(VAS)和伯格曼舒适度量表(BCS)评分,对比两组产妇术后0~12 h、>12~24 h、>24~36 h及>36~48 h舒芬太尼剂量,并记录患者住院期间恶心呕吐、呼吸抑制等不良反应。结果观察组术后首次按压镇痛泵时间晚于对照组,镇痛补救率、24 h内按压次数低于对照组(P<0.05);产妇首次站立、下床活动及术后初乳时间低于对照组,差异有统计学意义(P<0.05);术后8、12、24、48 h VAS评分低于对照组、但各时间点BCS评分高于对照组,差异有统计学意义(P<0.05);0~12 h、>12~24 h及>24~36 h舒芬太尼用量低于对照组,差异有统计学意义(P<0.05);观察组不良反应总发生率(7.14%)低于对照组(22.50%),差异有统计学意义(P<0.05)。结论QLB较TAPB能够为剖宫术产妇提供多模式镇痛效果,降低舒芬太尼消耗量,减少不良反应发生。

Objective To investigate the safety and efficacy in cesarean section between ultrasound-guided l quadratus lumborum block(QLB)and transverse abdominis plane block(TAPB)in cesarean section.Methods A total of 82 parturients undergoing cesarean section were randomly divided into control and observation groups.Continuous epidural anesthesia was administered in both groups.Under ultrasound guidance,TAPB was conducted on control group,while QLB was conducted on observation group.Two groups were treated with ropivacaine and patient-controlled intravenous analgesia(PCIA)after surgery.Two groups were compared on the first pressing time of analgesic pump,the number of effective pressings within 24 hours,the pain relief rate and postoperative recovery indicators.Two groups were observed on visual analogue scale(VAS)and Bergman Comfort Scale(BCS)at 4,8,12,24,and 48 h after surgery.Sufentanil dosages were compared between two groups at 0-12 h,>12-24 h,>24-36 h,and>36-48 h after surgery.Adverse reactions such as nausea,vomiting and respiratory depression were recorded during hospitalization.Results The first pressing time of the analgesic pump was later in observation group than that in control group.The pain relief rate and the number of effective pressings within 24 hours were lower in observation group than those in control group(P<0.05).The first maternal standing time,the time to get out of bed after surgery and postoperative colostrum time were lower in observation group than those in control group(P<0.05).VAS scores at 8,12,24,and 48 h after surgery were lower in observation group than those in control group,but BCS scores at each time point were higher than those in control group(P<0.05).Sufentanil dosages at 0-12 h,>12-24 h,and>24-36 h were lower in observation group than those in control group(P<0.05).The total incidence of adverse reactions in observation group(7.14%)was lower than that in control group(22.50%,P<0.05).Conclusion When compared to TAPB,QLB can provide multimodal analgesic effects,reduce sufentanil consumption and minimize adverse reactions for patients undergoing cesarean section,therefore QLB has high clinical value.